EP2674135A1 - Systems and methods for deploying a portion of a stent using at least one coiled member - Google Patents
Systems and methods for deploying a portion of a stent using at least one coiled member Download PDFInfo
- Publication number
- EP2674135A1 EP2674135A1 EP20130171753 EP13171753A EP2674135A1 EP 2674135 A1 EP2674135 A1 EP 2674135A1 EP 20130171753 EP20130171753 EP 20130171753 EP 13171753 A EP13171753 A EP 13171753A EP 2674135 A1 EP2674135 A1 EP 2674135A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- coiled member
- stent
- proximal
- cannula
- distal
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 238000000034 method Methods 0.000 title abstract description 20
- 230000001681 protective effect Effects 0.000 claims abstract description 66
- 230000008878 coupling Effects 0.000 claims description 35
- 238000010168 coupling process Methods 0.000 claims description 35
- 238000005859 coupling reaction Methods 0.000 claims description 35
- 230000004323 axial length Effects 0.000 claims description 11
- 210000005166 vasculature Anatomy 0.000 claims description 2
- 239000000463 material Substances 0.000 description 33
- 230000007704 transition Effects 0.000 description 18
- 230000002829 reductive effect Effects 0.000 description 17
- 229910001000 nickel titanium Inorganic materials 0.000 description 12
- 230000008901 benefit Effects 0.000 description 10
- HLXZNVUGXRDIFK-UHFFFAOYSA-N nickel titanium Chemical compound [Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni] HLXZNVUGXRDIFK-UHFFFAOYSA-N 0.000 description 10
- 230000007246 mechanism Effects 0.000 description 6
- 238000000926 separation method Methods 0.000 description 6
- 229910000679 solder Inorganic materials 0.000 description 6
- 206010002329 Aneurysm Diseases 0.000 description 5
- 238000003384 imaging method Methods 0.000 description 5
- 230000000670 limiting effect Effects 0.000 description 5
- 208000027418 Wounds and injury Diseases 0.000 description 4
- 230000006835 compression Effects 0.000 description 4
- 238000007906 compression Methods 0.000 description 4
- 241001631457 Cannula Species 0.000 description 3
- 230000001154 acute effect Effects 0.000 description 3
- 239000000560 biocompatible material Substances 0.000 description 3
- 239000012530 fluid Substances 0.000 description 3
- 238000003698 laser cutting Methods 0.000 description 3
- 230000008569 process Effects 0.000 description 3
- 230000000717 retained effect Effects 0.000 description 3
- 229910001285 shape-memory alloy Inorganic materials 0.000 description 3
- 229910001220 stainless steel Inorganic materials 0.000 description 3
- 239000010935 stainless steel Substances 0.000 description 3
- RTAQQCXQSZGOHL-UHFFFAOYSA-N Titanium Chemical compound [Ti] RTAQQCXQSZGOHL-UHFFFAOYSA-N 0.000 description 2
- 229910045601 alloy Inorganic materials 0.000 description 2
- 239000000956 alloy Substances 0.000 description 2
- 230000006378 damage Effects 0.000 description 2
- 230000001419 dependent effect Effects 0.000 description 2
- 239000013013 elastic material Substances 0.000 description 2
- 238000003780 insertion Methods 0.000 description 2
- 230000037431 insertion Effects 0.000 description 2
- 239000003550 marker Substances 0.000 description 2
- 229910052751 metal Inorganic materials 0.000 description 2
- 239000002184 metal Substances 0.000 description 2
- 150000002739 metals Chemical class 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000036961 partial effect Effects 0.000 description 2
- BASFCYQUMIYNBI-UHFFFAOYSA-N platinum Chemical compound [Pt] BASFCYQUMIYNBI-UHFFFAOYSA-N 0.000 description 2
- 229920000642 polymer Polymers 0.000 description 2
- 230000002441 reversible effect Effects 0.000 description 2
- 229910052719 titanium Inorganic materials 0.000 description 2
- 239000010936 titanium Substances 0.000 description 2
- 229910000684 Cobalt-chrome Inorganic materials 0.000 description 1
- HZEWFHLRYVTOIW-UHFFFAOYSA-N [Ti].[Ni] Chemical compound [Ti].[Ni] HZEWFHLRYVTOIW-UHFFFAOYSA-N 0.000 description 1
- 230000002411 adverse Effects 0.000 description 1
- 210000003484 anatomy Anatomy 0.000 description 1
- 238000002399 angioplasty Methods 0.000 description 1
- 230000004888 barrier function Effects 0.000 description 1
- 238000003486 chemical etching Methods 0.000 description 1
- 239000010952 cobalt-chrome Substances 0.000 description 1
- 238000011010 flushing procedure Methods 0.000 description 1
- PCHJSUWPFVWCPO-UHFFFAOYSA-N gold Chemical compound [Au] PCHJSUWPFVWCPO-UHFFFAOYSA-N 0.000 description 1
- 229910052737 gold Inorganic materials 0.000 description 1
- 239000010931 gold Substances 0.000 description 1
- 238000000227 grinding Methods 0.000 description 1
- 230000001939 inductive effect Effects 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 239000007769 metal material Substances 0.000 description 1
- 238000012856 packing Methods 0.000 description 1
- 230000037361 pathway Effects 0.000 description 1
- 229910052697 platinum Inorganic materials 0.000 description 1
- 230000000452 restraining effect Effects 0.000 description 1
- 239000007787 solid Substances 0.000 description 1
- 229910052715 tantalum Inorganic materials 0.000 description 1
- GUVRBAGPIYLISA-UHFFFAOYSA-N tantalum atom Chemical compound [Ta] GUVRBAGPIYLISA-UHFFFAOYSA-N 0.000 description 1
- 229920001169 thermoplastic Polymers 0.000 description 1
- 239000004416 thermosoftening plastic Substances 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
- 238000004804 winding Methods 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
- A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
- A61F2/91—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
- A61F2002/075—Stent-grafts the stent being loosely attached to the graft material, e.g. by stitching
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2002/9505—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2002/9534—Instruments specially adapted for placement or removal of stents or stent-grafts for repositioning of stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
- A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
- A61F2002/9665—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod with additional retaining means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0008—Fixation appliances for connecting prostheses to the body
- A61F2220/0016—Fixation appliances for connecting prostheses to the body with sharp anchoring protrusions, e.g. barbs, pins, spikes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0004—Rounded shapes, e.g. with rounded corners
- A61F2230/0013—Horseshoe-shaped, e.g. crescent-shaped, C-shaped, U-shaped
Definitions
- the present embodiments relate generally to apparatus and methods for treating medical conditions, and more specifically, to systems and methods for deploying a portion of a stent using at least one coiled member.
- Stents may be inserted into an anatomical vessel or duct for various purposes. Stents may maintain or restore patency in a formerly blocked or constricted passageway, for example, following a balloon angioplasty procedure. Other stents may be used for different procedures, for example, stents placed in or about a graft have been used to hold the graft in an open configuration to treat an aneurysm. Additionally, stents coupled to one or both ends of a graft may extend proximally or distally away from the graft to engage a healthy portion of a vessel wall away from a diseased portion of an aneurysm to provide endovascular graft fixation.
- Stents may be either self-expanding or balloon-expandable, or they can have characteristics of both types of stents.
- Self-expanding stents may be delivered to a target site in a compressed configuration and subsequently expanded by removing a delivery sheath, removing trigger wires and/or releasing diameter reducing ties. With self-expanding stents, the stents expand primarily based on their own expansive force without the need for further mechanical expansion.
- the shape memory alloy may be employed to cause the stent to return to a predetermined configuration upon removal of the sheath or other device maintaining the stent in its predeployment configuration.
- the trigger wires When trigger wires are used as a deployment control mechanism, the trigger wires may releasably couple the proximal and/or distal ends of a stent or stent-graft to a delivery catheter.
- one or more trigger wires are looped through a portion of the stent near a vertex of the stent.
- trigger wires may be used to restrain a "Z-stent" or Gianturco stent comprising a series of substantially straight segments interconnected by a series of bent segments. The trigger wires may be disposed through, and pull upon, the bent segments to pull the stent closely against the delivery catheter.
- Trigger wires also may be used in conjunction with different stent designs, such as cannula-cut stents having relatively acute or pointed bends.
- the designs of cannula-cut stents may facilitate compression of the stent to a relatively small delivery profile due to the tight bends of the apices.
- the trigger wires may be looped around one or more vertices formed beneath the proximal and/or distal apices, e.g., a location where an individual apex splits into two separate strut segments.
- trigger wires are threaded through the vertices of such cannula-cut stents, the trigger wires may become crimped at the vertices during compression of the stent to a reduced diameter delivery profile. If the trigger wires are crimped between the strut segments, the trigger wires and/or stent segments may become damaged during delivery, particularly for nickel-titanium stents that may be sensitive to surface imperfections. Furthermore, when compressing a cannula-cut stent having relatively acute bends to a significantly reduced radial profile, barbs disposed near the apices of the stent may become entangled with the stent struts and/or the trigger wires. Still further, in some instance, trigger wires may require a relatively high deployment force when being retracted, and the provision of multiple trigger wires may add to the profile of the delivery system.
- the present invention seeks to provide an improved system and method for deploying a stent.
- the system comprises a cannula having an outer surface, and at least one coiled member having proximal and distal ends and a plurality of turns disposed therebetween.
- One of the proximal and distal ends of the coiled member is secured to the outer surface of the cannula, and the other of the proximal and distal ends of the coiled member is unsecured relative to the outer surface of the cannula.
- a portion of a stent is looped around the unsecured end of the coiled member and disposed within spacing between adjacent turns of the coiled member. Rotation of the cannula subsequently causes the portion of the stent to disengage from the coiled member.
- the distal end of the coiled member is secured to the outer surface of the cannula and the proximal end of the coiled member is unsecured relative to the outer surface of the cannula.
- a portion of the stent is looped around the proximal end of the coiled member and further is disposed within spacing between adjacent proximal turns of the coiled member in the delivery state.
- the proximal end of the coiled member is secured to the outer surface of the cannula and the distal end of the coiled member is unsecured relative to the outer surface of the cannula, and a portion of the stent is looped around the distal end of the coiled member and further is disposed within spacing between adjacent distal turns of the coiled member in the delivery state.
- a distal series of turns of the coiled member may be spaced apart further from one another relative to spacing between a proximal series of turns.
- a first diameter at the proximal end of the coiled member permits attachment to the outer surface of the cannula, while a second diameter at the distal end of the coiled member is greater than the first diameter and there is a gap disposed between the distal end of the coiled member and the outer surface of the cannula.
- first and second coiled members are provided and are longitudinally spaced apart from one another along a length of the cannula.
- the first coiled member engages a first stent portion in the delivery state and the second coiled member engages a second stent portion in the delivery state.
- the first coiled member may comprise a greater number of turns that are unsecured relative to the cannula than the second coiled member, thereby enabling the second stent portion to disengage from the second coiled member before the first stent portion disengages from the first coiled member when the cannula is rotated in a uniform direction.
- a ring portion may extend from the stent and is dimensioned to be accommodated within the spacing between adjacent turns of the coiled member in the delivery state.
- At least one suture loop comprises a proximal region that is coupled to the cannula, and a distal region that is retained within one of the plurality of turns of the coiled member in the delivery state.
- the suture loop is further coupled around a portion of a stent in the delivery state. Rotation of the cannula causes longitudinal movement of the distal region of the suture loop relative to the proximal region of the suture loop, thereby varying the slack in the suture loop and varying expansion of the portion of the stent that is coupled to the suture loop.
- a protective cage may encircle the coiled member.
- the protective cage is circumferentially rotatable relative to the cannula.
- An atraumatic tip may be coupled to the cannula, such that at least a portion of the atraumatic tip is disposed beneath the protective cage, and the protective cage can rotate circumferentially relative to the atraumatic tip and the cannula.
- a distal stop member may be coupled to the cannula and positioned adjacent to a distal end of the protective cage. The distal stop member allows the protective cage to rotate relative to the cannula, but prevents the protective cage from sliding distally over the cannula.
- the protective cage may comprise a plurality of struts separated by a plurality of slots. A portion of the stent that is temporarily coupled to the coiled member extends through one of the plurality of slots.
- each of the plurality of struts and each of the plurality of slots are generally parallel to each other in a direction running along a longitudinal axis of the apparatus.
- at least one of the plurality of slots has proximal and distal regions and a width at the proximal region is greater than a width at the distal region.
- a system for deploying at least a portion of a stent comprising: a rotatable cannula having an outer surface; at least one coiled member having proximal and distal ends and a plurality of turns disposed therebetween, where the distal end of the coiled member is secured to the outer surface of the cannula, and the proximal end of the coiled member is unsecured relative to the outer surface of the cannula; a stent disposed on the cannula; and at least one suture loop comprising a proximal region that is coupled to the cannula, and a distal region that is retained within one of the plurality of turns of the coiled member, where the suture loop is further coupled around a portion of a stent, and where rotation of the cannula causes longitudinal movement of the distal region of the suture loop relative to the proximal region of the suture loop, thereby varying the s
- the system comprises a swivel that is coupled to the cannula, where the proximal region of the suture loop is coupled to the swivel.
- This aspect can include the elements and features of the other embodiments disclosed herein.
- proximal refers to a direction that is generally closest to the heart during a medical procedure
- distal refers to a direction that is furthest from the heart during a medical procedure
- the apparatus 20 generally comprises a cannula 30 having an outer surface 31, and at least one coiled member 40 having a region that is secured to the outer surface 31 of the cannula 30.
- the cannula 30 may be incorporated as part of a broader stent or stent-graft delivery system, and may span a longitudinal length in which a distal segment extends outside of a patient's body, and a proximal segment 34, including the coiled member 40, is delivered towards a target site inside of a patient's body.
- the cannula 30 may be used as an inner cannula, to the extent that one or more outer cannulas or sheaths are disposed coaxially over the cannula 30.
- a stent-graft may be disposed over an exterior surface of the cannula 30 and within one or more outer cannulas or sheaths, thereby encompassing the stent-graft during a delivery stage.
- the cannula 30 may comprise a tubular member having a lumen sized to allow the cannula 30 to be advanced over a wire guide during delivery.
- a proximal region of the cannula 30 may be integrally formed with, or externally coupled to, an atraumatic tip 35.
- the atraumatic tip 35 may comprise proximal and distal regions 36 and 37, respectively, and a central region 38 disposed therebetween.
- the proximal and distal regions 36 and 37 comprise a smaller outer diameter relative to the central region 38, with a first taper allowing for a smooth transition between the proximal region 36 and the central region 38, and a second taper allowing for a smooth transition between the distal region 37 and the central region 38.
- the coiled member 40 comprises a proximal end 41, a distal end 42, and a plurality of turns 43 disposed therebetween, as shown in FIGS. 1-2 .
- the proximal end 41 of the coiled member 40 is secured to the outer surface 31 of the cannula 30 using a suitable mechanism, such as a solder, weld, mechanical attachment, friction fit, crimp, or combination of these or other techniques and mechanisms. Accordingly, the proximal end 41 of the coiled member 40 cannot move relative to the outer surface 31 of the cannula 30.
- the proximal end 41 of the coiled member 40 comprises a first diameter d 1 , which may be approximately the same diameter, or slightly greater than, an outer diameter of the cannula 30.
- the distal end 42 of the coiled member 40 is unsecured relative to the outer surface 31 of the cannula 30, as shown in FIGS. 1-2 .
- the distal end 42 of the coiled member 40 may comprise a second diameter d 2 , which is greater than the first diameter d 1 of the proximal end 41 of the coiled member 40.
- the plurality of turns 43 are divided into a proximal series of turns 43a, which have the first diameter d 1 , and a distal series of turns 43b, which have the second diameter d 2 .
- the proximal series of turns 43a may be disposed in close proximity or abutting one another, as depicted in FIG. 2 .
- the distal series of turns 43b may be spaced apart from one another a greater distance than the proximal series of turns 43a.
- the distal series of turns 43b are spaced apart a predetermined distance denoted by spacing 45.
- a portion of a stent 60 may be coupled to at least one of the distal series of turns 43b, and secured within the spacing 45 between adjacent distal turns.
- the exemplary coiled member 40 may be formed from stainless steel, Nitinol, titanium, or other suitable biocompatible materials. If manufactured from Nitinol, the unsecured end of the coiled member may be heat-set so that it contracts around the outer surface 31 of the cannula 30 when disposed within the body, thereby reducing the likelihood of the coiled member 40 snagging the stent 60 or other components.
- the coiled member 40 is formed from a material that has radiopaque properties.
- an exemplary stent-graft 50 having a proximally-located stent 60 coupled to a graft material 90, may be deployed in a controlled manner using the coiled member 40 of FIGS. 1-2 , as shown further in the exemplary coupling sequence of FIGS. 4-5 below.
- the stent 60 may be manufactured from a continuous cylinder into which a pattern may be cut by a laser or by chemical etching to produce slits in the wall of the cylinder. The resulting structure may then be heat set to give it a desired final configuration. As shown in FIG.
- the final configuration may include a shape having a series of proximal apices and a series of distal apices.
- a proximal end 62 of the stent 60 may comprise multiple adjacent proximal apices 62a and 62b, while a distal end 64 of the stent 60 may comprise multiple adjacent distal apices 64a and 64b, as shown in FIG. 3 .
- At least one pair of adjacent, proximal apices 62a and 62b may comprise different features.
- a first proximal apex 62a may comprise an end region 70 having a bore 71 formed therein, wherein the bore 71 is configured to receive a suture loop 65, as explained further below.
- a second, adjacent proximal apex 62b may comprise an end region 75 having an integral barb 77 formed therein, as shown in FIG. 3 .
- the barb 77 may be formed by laser cutting a desired barb shape into the end regions 75.
- a slit 76 therefore is formed into each end region 75 after the desired barb shape is formed, as shown in FIG. 3 .
- a main body of the barb 77 may be bent in a radially outward direction with respect to the end region 75.
- the angle may comprise any acute angle, or alternatively may be substantially orthogonal or obtuse.
- the barb 77 may be sharpened, for example, by grinding the tip of the barb, to facilitate engagement at a target tissue site.
- the stent 60 may comprise at least one strut segment disposed between the proximal and distal apices.
- multiple angled strut segments may be disposed between a first proximal apex 62a and a corresponding distal apex 64a, and an identical set of angled strut segments may be disposed between an adjacent, second proximal apex 62b and a corresponding distal apex 64b.
- a first proximal apex 62a extends distally and splits into first and second angled strut segments 67 and 68, respectively, thereby forming a proximal vertex 78, as shown in FIG.
- first and second angled strut segments 67 and 68 may be compressed such that they are substantially parallel to one another.
- each distal apex 64a and 64b may extend in a proximal direction and split into the first and second angled strut segments 67 and 68, respectively, thereby forming a distal vertex 79.
- a first angled strut segments 67 may meet with an adjacent second angled strut segment 68, thereby forming a transition region 80.
- the stent 60 may be formed into a continuous, generally cylindrical shape, as shown in FIG. 3 .
- Expansion of the stent 60 is at least partly provided by the angled strut segments 67 30 and 68, which may be substantially parallel to one another in a compressed state, but may tend to bow outward away from one another in the expanded state shown in FIG. 3 .
- the stent 60 may be formed from any suitable material, such as a laser-cut Nitinol cannula. If manufactured from Nitinol, the stent 60 may be inclined to assume the expanded state shown in FIG. 3 upon removal of a delivery sheath or engagement with the coiled member 40, as explained in FIGS. 4-5 below.
- Each transition region 80 may comprise a larger surface area relative to the angled segments, since the transition regions are composed substantially of multiple different angled segments 67 and 68.
- the stent 60 may comprise at least one barb 82 disposed in at least one of the transition regions 80.
- the barb 82 may be formed integrally, as part of the strut, or may comprise an external barb that is adhered to a surface of the transition regions 80. As shown in FIG. 3 , multiple integral barbs 82 are provided. Like the barbs 77 noted above, the barbs 82 may be formed by laser cutting a desired barb shape into the transition regions 80. A slit 81 therefore is formed into the transition region 80 after the desired barb shape is formed, as shown in FIG. 3 .
- transition regions 80 may comprise an increased surface area relative to other regions of the stent 60, it may be easier to perforate portions of the transition regions 80 without adversely affecting the structural integrity of the stent.
- a main body of the barb 82 may be bent in an outward direction at any angle with respect to the transition region 80 and optionally may be sharpened to facilitate engagement at a target tissue site.
- Each of the distal apices 64a and 64b may comprise an end region 88 having a bore 89 formed therein, as shown in FIG. 3 .
- the distal end 64 of the stent 60 may be coupled to a proximal end 92 of the graft material 90.
- the distal apices 64a and 64b may be coupled to the graft material, for example, using one or more sutures that are looped through the graft material and the bores 89 of the stent 80. In this manner, the stent 60 may be used as an attachment stent for endovascular graft fixation.
- the graft material 90 may overlap with an aneurysm to seal off fluid flow into the aneurysm, while the proximal end 62 of the stent 60 may extend in a proximal direction away from the graft material, e.g., to engage a healthy portion of a vessel wall away from a diseased portion of the aneurysm.
- one or more additional stents may be coupled to an inner or outer surface of the graft material 90, i.e., at a location distal to the stent 60, to help maintain patency throughout the graft material.
- exemplary zig-zag stents 95 are shown coupled to the graft material 90 between the proximal and distal ends 92 and 94 of the graft material 90 in FIGS. 4-5 , it will be apparent than any shape of stent may be used, and such stents may be coupled to either the inner or outer surfaces of the graft material 90.
- the stent 60 has a reduced diameter delivery state so that it may be advanced to a target location within a vessel or duct.
- the stent 60 also has an expanded deployed state to apply a radially outward force upon at least a portion of a vessel or duct, e.g., to maintain patency within a passageway, or to hold open the lumen of a graft. In the expanded state, fluid flow is allowed through a central lumen of the stent 60.
- the struts of the stent 60 may comprise a substantially flat wire profile or may comprise a rounded profile. As best seen in FIG. 3 , the struts of the stent 60 generally comprise a flat wire profile.
- the stent 60 may be manufactured from a super-elastic material.
- the super-elastic material may comprise a shape-memory alloy, such as a nickel titanium alloy (Nitinol).
- Nitinol nickel titanium alloy
- the stent 60 may be heat-set into the desired expanded state, whereby the stent 60 can assume a relaxed configuration in which it assumes the preconfigured first expanded inner diameter upon application of a certain cold or hot medium.
- the stent 60 may be made from other metals and alloys that allow the stent 60 to return to its original, expanded configuration upon deployment, without inducing a permanent strain on the material due to compression.
- the stent 60 may comprise other materials such as stainless steel, cobalt-chrome alloys, amorphous metals, tantalum, platinum, gold and titanium.
- the stent 60 also may be made from non-metallic materials, such as thermoplastics and other polymers.
- While one exemplary stent 60 is shown in FIG. 3 and described in FIGS. 4-5 below, various alternative stent configurations may be used in conjunction with the coiled member 40 of FIGS. 1-2 . Moreover, the stent may be deployed alone, or as part of a stent-graft system, as depicted herein.
- FIGS. 4-5 an exemplary coupling of the stent-graft 50 of FIG. 3 to the deployment apparatus of FIGS. 1-2 is shown and described.
- the stent-graft 50 has an uncoupled state in which the stent-graft 50 is positioned coaxially over the cannula 30 with the proximal end 62 of the stent 60 in longitudinal proximity relative to the distal end 42 of the coiled member 40, as shown in FIG. 4 .
- the suture loops 65 that are coupled to the proximal apices 62a of the stent 60 are threaded around the distal end 42 of the coiled member 40 one at a time, preferably until all of the suture loops 65 are coupled to the coiled member 40.
- Such coupling may be achieved by rotating the cannula 30 in a clockwise direction until the proximal end 62 of the stent 60 is sufficiently compressed in a radially inward direction, as depicted in FIG. 5 .
- the gap 44 between the distal end 42 of the coiled member 40 and the outer surface 31 of the cannula 30 permits positioning of the suture loops 65 around the distal series of turns 43b.
- the suture loops 65 are further accommodated within the spacing 45 between the distal series of turns 43b.
- the suture loops 65 preferably are coupled to the coiled member 40 in a manner in which at least one suture loop 65 is positioned around at least one full turn of the distal series of turns 43b, and preferably around at least 1.5 turns at the distal end 42 of the coiled member 40, thereby reducing the likelihood of inadvertent uncoupling of the suture loops 65 from the coiled member 40.
- the coupling shown in FIG. 5 secures the stent 60 to the cannula 30 via the coiled member 40 in a manner that may subsequently facilitate insertion of the subassembly comprising the cannula 30 and the stent-graft 50 into an outer sheath.
- the outer sheath is configured to radially restrain other regions of the stent-graft 50 for delivery to a target site within a patient's anatomy.
- the suture loops 65 are coupled to every other proximal apex 62a to restrain the stent 60 during delivery.
- the suture loops 65 are not coupled to the second proximal apices 62b, which comprise the barbs 77.
- the adjacent second proximal apices 62b also may be indirectly pulled in a radially inward direction during delivery.
- the configuration of the stent 60, and in particular the angled segments 67 and 68 that meet up at transition regions 80 facilitates the indirect compression of the adjacent second proximal apices 62b. Since only selected ones of the proximal apices are restrained during delivery, the number of suture loops 65 may be reduced. Moreover, since the barbs 77 are only disposed on every other apex, barb entanglement may be reduced or eliminated.
- PCT application WO98/53761 describes a deployment system for an endoluminal prosthesis whereby the prosthesis is radially compressed onto a delivery catheter and is covered by an outer sheath. To deploy the system, the operator slides or retracts the outer sheath over the delivery catheter, thereby exposing the prosthesis. The prosthesis expands outwardly upon removal of the sheath. The operator can directly manipulate the sheath and the delivery catheter, which provides the operator with a relatively high degree of control during the procedure.
- trigger wires and any of their associated sleeves would not be necessary to deploy the stent-graft 50.
- the cannulas 30, 130, 130' and 230 and the coiled members 40, 140 and 180 of the present embodiments may be incorporated as part of the deployment system with the stent-graft 50 being positioned coaxially between the cannula 30 and the outer sheath.
- a mechanism such as a pin vise, may be employed to prevent inadvertent rotation of the cannula 30 prior to the intended rotation as described in the present application.
- a wire guide may be advanced to the target site, and the cannula 30 may be advanced over the wire guide to position the apparatus 20 at the desired location in proximity to the target site, with the atraumatic tip 35 reducing the likelihood of injury to bodily passageways during delivery.
- the outer sheath is disposed over the cannula 30 and the stent-graft 50 during insertion to the target site. Upon proper positioning at the target site using a desired imaging modality, the outer sheath is then retracted to expose at least a portion of the stent 60.
- the cannula 30 may be rotated in a counter-clockwise direction until the suture loops 65 are uncoupled from the coiled member 40, i.e., in a reverse manner from which the suture loops 65 were coupled to the coiled member 40.
- the stent 60 then may be deployed as shown in FIG. 4 , and the remainder of the stent-graft 50 may be deployed by further retraction of the outer sheath or actuation of any other devices that are radially constraining the remainder of the stent-graft 50.
- a plurality of coiled members may be used to selectively deploy multiple stent portions of the stent-graft 60.
- the proximal end 62 of the stent 60 is radially restrained without the use of convention trigger wires that span a full longitudinal length of the delivery system. Accordingly, the radial profile of the delivery system may be reduced without the provision of multiple trigger wires and one or more associated sleeves to house the trigger wires, thereby reducing packing density of the system. Moreover, deployment may be simplified as reduced deployment forces are expected to be needed relative to the use of conventional trigger wires.
- deployment of the stent 50 using the apparatus 20 comprising at least one coiled member 40 may allow for more precise positioning of the stent 50.
- deployment using the coiled member 40 may provide a more controlled unwinding of the associated portion of the stent 50, whereas the release of conventional trigger wires may require higher deployment forces that can cause a portion of the stent to jump longitudinally, thereby potentially deploying the stent offset from the intended target site.
- an alternative stent 60' is described for use with the apparatus 20 comprising at least one coiled member 40 as described in FIGS. 1-2 and FIGS. 4-5 .
- the alternative stent 60' is similar to the stent 60 of FIG. 3 , with a main exception that an alternative proximal end 62' comprises at least one alternative proximal apex 62b' having an region comprising an eyelet 72.
- the eyelet 72 may be formed within a ring portion 73 that is disposed at the proximal end of a proximal extension segment 74.
- the proximal extension segment 74 extends in a proximal direction away from the end region 75 having the integral barb 77, as shown in FIGS. 6-8 .
- the ring portion 73 and the proximal extension segment 74 comprise a wall thickness that is less than a wall thickness of the end region 75 having the integral barb 77, as best seen in FIG. 6 .
- the reduced wall thickness of the ring portion 73 and the proximal extension segment 74 allows at least the ring portion 73 to twist in a circumferential direction to facilitate loading of the proximal apex 62' around the coiled member 40.
- the ring portion 73 twists in a circumferential direction about 90 degrees between a first state shown in FIG. 7 and a second state shown in FIG. 8 .
- the ring portion 73 may twist greater or less than 90 degrees, and the exemplary depiction between the states of FIGS. 7 and 8 is not intended to be limiting. Moreover, at least a portion of the proximal extension segment 74 may twist in the circumferential direction. The proximal extension segment 74 may twist a greater amount proximally since it is further from attachment from the end region 75 having the greater wall thickness.
- the proximal extension segment 74 provides longitudinal separation of the ring portion 73 housing the eyelet 72 from the end region 75 having the integral barb 77. Accordingly, when the eyelet 72 is threaded around the coiled member 40, the proximal extension segment 74 provides a longitudinal spacing that reduces the likelihood of entanglement between the coiled member 40 and the integral barb 77 of the end region 75.
- the ring portion 73 and the proximal extension segment 74 may be integrally formed with the end region 75. If the stent 60' is formed from Nitinol or a similar material, the superelastic properties of such material can facilitate circumferential twisting of the ring portion 73 between the first and second states shown in FIGS. 7 and 8 .
- the alternative proximal apex 62b' shown in FIGS. 6-8 may be provided on each and every proximal apex of the stent 60'.
- the alternative proximal apex 62b' may be provided on fewer than all of the proximal apices of the stent 60', and the remaining proximal apices may be provided with only barbs, e.g., as depicted by the proximal apices 62b in FIG. 3 above, or the proximal apices may comprise other features.
- a further alternative stent 60" has a proximal end 62" having at least one proximal apex 62b", which is similar to the proximal apex 62b' of FIGS. 6-8 ,with a main exception that an alternative ring portion 73' having an eyelet 72' and proximal extension segment 74' are formed separately from the end region 75.
- a bore 83 is formed at a proximal edge of the end region 75 at a location spaced proximally away from the integral barb 77, as shown in FIG. 9 .
- a distal portion 84 of the proximal extension segment 74' is sized to be received within the bore 83 of the end region 75.
- the distal portion 84 of the proximal extension segment 74' then may be secured, e.g., using a solder or weld, within the bore 83 of the end region 75, forming the proximal apex 62b" shown in FIG. 9 .
- the ring portion 73' and the proximal extension segment 74' optionally may be formed of a different material, such as a more flexible material, relative to the remainder of the stent 60".
- a further alternative stent 60"' has a proximal end 62"' having at least one proximal apex 62b"'.
- a wire loop 54 is coupled to the end region 75 having the integral barb 77 by winding the wire loop 54 around a portion of the slit 76 formed into the end region 75.
- the wire loop 54 may be wound securely by placing a first loop portion 55 under the end region 75, then around the barb 77, and folding over proximally through the slot 76, as shown in FIG. 10 .
- a second loop portion 56 which preferably is larger than the first loop portion 55 and disposed primarily proximally to the first loop portion 55, may be pulled in a proximal direction as depicted in FIG. 11 .
- the first loop portion 55 shortens and tightens around the end region 75, as shown in FIG. 11 .
- a solder may be applied to hold the first loop portion 55 tightly around the end region 75.
- the resulting structure comprises the second loop portion 56 extending proximally away from the end region 75 in a manner such that the second loop portion 56 can be wound around the coiled member 40 of FIGS. 1-2 and 4-5 , in the manner generally described above with respect to the suture loop 65.
- the wire loop 54 may be formed from a flexible material. If formed from Nitinol or a similar material, the superelastic properties of such material can facilitate circumferential twisting of the second loop portion 56 between the first and second states shown in FIGS. 7 and 8 , thereby facilitating engagement around the coiled member 40. Moreover, the wire loop 54 may be considerably thinner than the end region 75 to facilitate engagement around the coiled member 40, e.g., by permitting twisting of the second loop portion 56 as needed during loading, and also by having a reduced thickness wire loop that can easily fit within the gap 44 and spacing 45 around the coiled member 40, as explained above.
- an alternative proximal region of a stent comprises alternating proximal apices 62a' and 62b.
- the proximal apices 62b are substantially identical to the proximal apices 62b described above in FIG. 3 .
- the proximal apices 62a' differ from the proximal apices 62a of FIG.
- the ring portion 73" may be disposed at the proximal end of the end region 70".
- the ring portion 73" then may be cut into this pattern in a manner integral with the remainder of the stent, e.g., by laser cutting a cannula.
- the ring portion 73" subsequently may be bent radially inward at a desired angle, such as between 45 and 90 degrees, and then heat-set into the bent position to facilitate engagement with the coiled member 40 described above.
- FIG. 13 is similar to FIG. 12 , with the exception that alternative proximal apices 62a" comprise end regions 70"' having ring portions 73"' that house eyelets 72"' that are positioned further distally, i.e., spaced apart from proximal end of the end regions 70"'.
- the eyelet positioning may be modified without departing from the spirit of the present embodiments.
- the ring portions housing the eyelet may be disposed further proximally than shown in FIG. 12 such that the ring portions extend proximally beyond then end of the adjacent proximal apices 62b.
- FIGS. 14-15 an alternative apparatus 120 is shown for deploying a plurality of stent portions using a plurality of coiled members.
- the apparatus 120 is similar to the apparatus 20 of FIGS. 1-2 and FIGS. 4-5 , with main exceptions noted below.
- the apparatus 120 of FIGS. 14-15 comprises a first coiled member 140 and a second coiled member 180, which are coupled to an outer surface 131 of a cannula 130 at locations that are longitudinally spaced apart from one another.
- the first coiled member 140 comprises a proximal end 141, a distal end 142, and a plurality of turns 143 disposed therebetween.
- the distal end 142 of the first coiled member 140 is secured to the outer surface 131 of the cannula 130 using a suitable mechanism, such as a solder, weld, mechanical attachment, friction fit, crimp, or combination of these or other techniques and mechanisms, as generally described above.
- the proximal end 141 of the first coiled member 140 is unsecured relative to the outer surface 131 of the cannula 130 at a location just proximal to an atraumatic tip 135, as shown in FIG. 14 .
- the proximal end 141 of the first coiled member 140 preferably comprises the second diameter d 2 , shown in FIG. 2 above, and provides the same separation or gap 44 described in FIG. 2 above between the proximal end 141 of the first coiled member 140 and the outer surface 131 of the cannula 130.
- the second coiled member 180 comprises a proximal end 181, a distal end 182, and a plurality of turns 183 disposed therebetween.
- the distal end 182 of the second coiled member 180 is secured to the outer surface 131 of the cannula 130, as generally described above, at a location distally spaced apart from the first coiled member 140, as shown in FIGS. 14-15 .
- the proximal end 181 of the second coiled member 180 is unsecured relative to the outer surface 131 of the cannula 130, as shown in FIG. 14 .
- the proximal end 181 of the second coiled member 180 preferably comprises the second diameter d 2 and provides the same separation or gap 44 between the proximal end 181 of the second coiled member 180 and the outer surface 131 of the cannula 130.
- the first coiled member 140 is coupled to a first portion of the stent-graft 50', while the second coiled member 180 is coupled to a second portion of the stent-graft 50'.
- the first coiled member 140 is coupled to the suture loops 65 that are coupled to the proximal apices 62a of the stent 60, as explained in FIGS. 3-5 above, while the second coiled member 180 is coupled to a central region of the graft material 90.
- at least one inner stent 195 is coupled to an inner surface of the graft material 90 and configured to engage the coiled member 180, in the manner generally described above with respect to FIGS. 1-5 .
- first and second coiled members 140 and 180 may radially restrain different, spaced-apart sections of the stent-graft 50' during deployment.
- the first coiled member 140 has a greater number of proximal turns 143a that are spaced apart further relative to distal turns 143b to accommodate a portion of the stent-graft 50', relative to the number of proximal turns 183a that are spaced apart further relative to distal turns 183b on the second coiled member 180. Accordingly, by varying the number of proximally spaced-apart turns 143a and 183a on the first and second coiled members 140 and 180, respectively, one portion of the stent-graft 50' may be disengaged from its respective coiled member 140 or 180 before the other portion of the stent-graft 50'. In this example of FIGS.
- the stent 195 will disengage from the proximal turns 183a relatively fast to deploy the central portion of the stent-graft 50' shortly after the cannula 130 is rotated. Subsequently, as the cannula 130 is rotated further, the suture loops 65 coupled to the proximal apices 62a of the stent 60 will disengage from the greater number of proximal turns 143a of the first coiled member 140 to deploy the proximal stent 60, after the central portion of the stent-graft 50 has been deployed.
- any number of coiled members may be provided along the length of the cannula to selectively control deployment of any number of corresponding regions along a stent or stent-graft.
- different portions of the stent or stent-graft may be selectively deployed before other portions simply by continuing to rotate a single cannula comprising the multiple coiled members.
- the portions of the stent-graft 50' that are coupled to the first and second coiled members 140 and 180 may be at least partially opened and closed to allow for a degree of repositioning before final deployment. For example, rotating the cannula 130 in a first direction may cause the portions of the stent-graft 50' to expand at least partially radially outward, while rotation in the opposing direction may cause the portions of the stent-graft 50' to contract radially inward, and this may be repeated any number of times before final deployment.
- the cannula may be rotated in the opposite direction to achieve deployment, as compared to the coiled member 40 of FIGS. 1-2 that is unsecured at its distal end.
- the cannula may comprise one or more coiled members that are unsecured at their proximal ends or unsecured at their distal ends, or combinations thereof in which at least one coiled member is unsecured proximally and at least one coiled member is unsecured distally.
- a stent 195a comprise a zig-zag shape comprising first and second generally straight segments 191 and 192 that are angled relative to one another and separated by a plurality of apices 193.
- An eyelet 194 may be coupled to one of the apices 193, as shown in FIG. 16 , or any other suitable segment of the stent 195a.
- the unsecured, spaced-apart proximal turns 183a of the second coiled member 180 are disposed through the eyelet 194 of the stent 195a, thereby securing the stent 195a to the second coiled member 180.
- a stent 195b comprises a cannula-cut structure having first and second cells 196a and 196b, which are separated by a spacing.
- a partial circumferential slit 197 is formed in the spacing to create a ring member 198, and a bore 199 then is formed within the ring member 198, as depicted in FIG. 17 .
- the ring member 198 having the bore 199 then may be bent radially inward at a desired angle, such as between 45 and 90 degrees, and then heat-set into the bent position, as generally described with respect to the ring member 73" and 73"' of FIGS. 12-13 , to facilitate engagement with the second coiled member 180.
- an alternative apparatus 120' is shown for deploying a plurality of stent portions using a plurality of coiled members, and is similar to the apparatus 120 of FIGS. 14-15 , with main exceptions noted below.
- an alternative cannula 130' of the apparatus 120' comprises a plurality of tapers 165 and 166 that increase in diameter from distal to proximal directions.
- the largest diameters of the tapers 165 and 166 generally match the second diameters d 2 , explained above in FIG. 2 , of the first and second coiled members 140 and 180, respectively. Accordingly, the proximal ends of the tapers 165 and 166 are substantially flush with the outer diameters d 2 of the first and second coiled members 140 and 180.
- the distal ends 142 and 182 of the first and second coiled members 140 and 180 may be secured to the proximal ends of the tapers 165 and 166, respectively, e.g., using a solder or other suitable technique, thereby eliminating the provision of the smaller turns of the first and second coiled members 140 and 180.
- a further alternative apparatus 220 is shown for deploying a portion of a stent 260 using a coiled member 240.
- a cannula 230 which is similar to the cannula 30 described above, comprises an outer surface 231, an atraumatic tip 235, and a wire guide lumen 239.
- the coiled member 240 comprises proximal and distal ends 241 and 242, respectively, and a plurality of turns 243 disposed therebetween.
- the distal end 242 of the coiled member 240 is secured to the outer surface 231 of the cannula 230, e.g., using solder or weld 249, while the proximal end 241 of the coiled member 240 is unsecured relative to the outer surface 231 of the cannula 230, as depicted in FIGS. 19-20 .
- the apparatus 220 further comprises a swivel 270 coupled to the cannula 230 at a location proximal to the coiled member 240, and a plurality of suture loops 275a and 275b.
- Each of the suture loops 275a and 275b comprises a proximal region 276 that is coupled to the swivel 270, e.g., by being disposed through a bore 271 in the swivel 270, and further comprises a distal region 277 that is retained in a delivery state beneath one of the plurality of turns 243 of the coiled member 240, as depicted in FIGS. 19-20 .
- the stent 260 comprises a first proximal apex 262a that is coupled to the suture loop 275a, and further comprises a second proximal apex 262b that is coupled to the suture loop 275b.
- the suture loops 275a and 275 are disposed around portions of the first and second proximal apices 262a and 262b, respectively, in a manner that restrains the first and second proximal apices 262a and 262b in the delivery state of FIG. 19 .
- the first and second proximal apices 262a and 262b of the stent 260 are movable between a first configuration of FIG. 19 in which they are restrained radially inward, a second configuration of FIG. 20 in which they are at least partially deployed radially outward, and a final configuration in which they are fully deployed.
- a first configuration of FIG. 19 in which they are restrained radially inward
- a second configuration of FIG. 20 in which they are at least partially deployed radially outward
- a final configuration in which they are fully deployed.
- the distal regions 277 of the suture loops 275a and 275b are positioned beneath the plurality of turns 243 at a location distally away from the swivel 270, thereby maintaining the suture loops 275a and 275b in a state of relative tension in which the suture loops 275a and 275b are generally parallel to the cannula 230, which holds the first and second proximal apices 262a and 262b in a radially restrained state.
- the cannula 230 may be rotated in a direction that causes the distal regions 277 of the suture loops 275a and 275b to move closer to the swivel 270, thereby providing slack for the suture loops 275a and 275b and allowing the first and second proximal apices 262a and 262b to be at least partially deployed radially outward based on their resilient nature.
- the physician may then rotate the cannula 230 in an opposing direction that causes the suture loops 275a and 275b to resume a state of relative tension to move the first and second proximal apices 262a and 262b radially inward to the state of FIG. 19 , thereby allowing for repositioning of the first and second proximal apices 262a any number of times after partial deployment. Therefore, the embodiment of FIGS. 19-20 provides a degree ofreversibility prior to final deployment.
- a physician can deploy the first and second proximal apices 262a and 262b at the desired location by rotating the cannula 230 to cause the distal regions 277 of the suture loops 275a and 275b to pass proximally beyond the proximal end 241 of the coiled member 240.
- the suture loops 275a and 275b are then free from engagement with the first and second proximal apices 262a and 262b, and the cannula 230 may be removed from the patient's body with the suture loops 275a and 275b still coupled to the swivel 270.
- a single trigger wire or other means may be used to temporarily lock the swivel 270 in place circumferentially as the stent 260 is positioned within the body.
- the single trigger wire or other means can be disengaged from the swivel 270, e.g., by being withdrawn from one of the bores 271 of the swivel 270, upon proper orientation within the body when the stent 260 is still in the delivery state, to thereby permit subsequent rotation of the swivel 270 and allowing unwinding of the suture loops 275a and 275b from the coiled member 240 as the cannula 230 is rotated.
- an apparatus 320 is shown for deploying a portion of a stent 360 using at least one coiled member 140, and comprises a protective cage 370 for enclosing the coiled member 140.
- the exemplary coiled member 140 is the same coiled member that is secured to the outer surface 131 of the cannula 130, as explained above in FIG. 14 , though it is contemplated that the protective cage 370 may be used in conjunction with other coiled members, including those alternative coiled members shown herein.
- the protective cage 370 comprises a first end 371 having an outer diameter dc 1 , and a second end 372 having a second outer diameter dc 2 , as best seen in FIGS. 21 and 24 .
- first end 371 having the first outer diameter dc 1 will be the proximal end of the protective cage 370
- the second end 372 having the second outer diameter dc 2 will be the distal end of the protective cage 370.
- the diameter at the first or proximal end 371 of the protective cage 370 can be larger to accommodate the greater diameter of the coil at its unsecured proximal end that is spaced apart relative to the cannula 130, as depicted by separation or gap 44 in FIG. 2 above.
- the reduced second outer diameter dc 2 may be provided because the diameter of the coiled member 140 is reduced for coupling to the cannula 130.
- the second or distal end 372 of the protective cage 370 may be positioned distally of the coiled member 140, as shown in FIG. 21 , and the second outer diameter dc 2 may be slightly larger than the outer surface 131 of the cannula 130.
- a taper 374 reduces the diameter of the protective cage 370 between the first end having the outer diameter dc 1 and the second end having the reduced outer diameter dc 2 .
- the axial orientation of the protective cage 370 may be reversed.
- the protective cage 370 may have the first end 371 of greater diameter located distally, while the second end 372 of lesser diameter is located proximally, thereby generally corresponding to the shape of the coiled member.
- the protective cage 370 further comprises a plurality of struts 375 separated by a plurality of slots 376.
- four struts 375a-375d are depicted as being separated by four slots 376a-376d, as depicted among the various FIGS. 21-22 , 23A-23C and 24 .
- any number of slots and struts may be provided.
- the number of slots may correspond directly to the number of proximal apices 361 of the stent 360 that need to be restrained, as generally depicted in FIG. 22 and explained below, or there may be variability between the number of slots and the number of proximal apices of the stent 360.
- Each of the struts 375a-375d and slots 376a-376d have proximal and distal ends, and are generally parallel to each other in a direction running along a longitudinal axis of the apparatus, as shown in FIG. 21 .
- Each of the slots 376a-376d has a width that is greater than a width of the proximal apices 361 of the stent 360, thereby allowing portion of the proximal apices 361 to extend through an associated slot, as depicted in FIG. 22 .
- Each of the slots 376a-376d may accommodate one proximal apex 361, or multiple proximal apices.
- the protective cage 370 is designed to cooperate with at least a portion of an atraumatic tip 335.
- the atraumatic tip 335 may comprise proximal and distal regions 336 and 337, respectively, and a central region 338 disposed therebetween.
- the proximal and distal regions 336 and 337 comprise a smaller outer diameter relative to the central region 338, with a first taper allowing for a smooth transition between the proximal region 336 and the central region 338, and a second taper allowing for a smooth transition between the distal region 337 and the central region 338.
- the proximal region 336 may comprise a similar shape to the proximal region 36 of the atraumatic tip 35 of FIG. 1 and FIGS. 4-5 .
- the distal region 337 of the atraumatic tip 335 may comprise an outer surface that corresponds to the shape of an inner surface at a proximal region of the protective cage 370.
- the protective cage 370 comprises a proximal inner taper 381, as shown in FIG. 24 .
- the outer surface of the distal region 337 of the atraumatic tip 335 generally annularly abuts the proximal inner taper 381 in an assembled state.
- the protective cage 370 can rotate circumferentially relative to the atraumatic tip 335 and the cannula 130.
- the proximal inner taper 381 of the protective cage 370 is disposed around the distal region 337 of the atraumatic tip 335, while the distal end 372 of the protective cage 370 is disposed around the outer surface 131 of the cannula 130. Since the proximal and distal regions of the protective cage 370 are not secured to the atraumatic tip 335 and the cannula 130, respectively, the protective cage 370 can rotate circumferentially relative to these adjacent components.
- a distal stop member 379 may be positioned adjacent to the distal end 372 of the protective cage 370, as shown in FIG. 21 .
- the distal stop member 379 allows the protective cage 370 to rotate relative to the cannula 130, but prevents the protective cage 370 from sliding distally over the cannula 130.
- the distal stop member 379 may be formed integrally with the cannula 130, or as an external component secured to the outer surface 131 of the cannula, and may comprise any suitable biocompatible material.
- the proximal inner taper 381 of the protective cage 370 extends inward to an opening 382, shown in FIG. 24 , which has a diameter that allows passage of the cannula 130 so that the cannula 130 can be coupled to the atraumatic tip 335.
- a stepped surface 383 is provided just distal to the opening 382, as shown in FIG. 24 .
- the stepped surface 383 may be generally perpendicular to the longitudinal axis of the cannula 130.
- the stepped surface 383 prevents the proximal apices 361 of the stent 360 from sliding off of the coiled member 140 prematurely, and may reduce the possibility that the proximal apices 361 of the stent 360 become inadvertently lodged under the struts 375a-375d.
- the proximal end 141 of the coiled member 140 is disposed immediately adjacent to the stepped surface 383, as depicted in FIG. 21 , thereby further reducing the possibility of inadvertent uncoupling of the proximal apices 361 of the stent 360 from the coiled member 140 prior to desired rotation of the cannula 130.
- the protective cage 370 further comprises a main housing 384, which is disposed between the stepped surface 383 and the distal end 372, as shown in FIG. 24 .
- the main housing 384 is sized for housing the coiled member 140 therein, and has an inner diameter that remains larger than the coiled member along its longitudinal length, thereby permitting rotation of the coiled member 140 within the main housing 384.
- the protective cage 370 may be formed from stainless steel, Nitinol, polymers, or other suitable biocompatible materials. Moreover, the protective cage 370 may be manufactured as a single component, or multiple components that are secured together. In one embodiment, the protective cage 370 may be manufactured by forming an outer shell of material, and then inserting material that forms the proximal inner taper 381 and the stepped surface 383, and separately cutting the slots 376a-376d into the outer shell.
- the stent 360 comprises a series of proximal apices 361 and a series of distal apices 363.
- Each of the proximal and distal apices 361 and 363 are separated by a plurality of strut segments 365 and 366, which enable radial expansion from the compressed state shown in FIG. 22 to a generally cylindrical expanded state similar to the stent 60 depicted in FIG. 4 .
- the distal apices 363 may be coupled to graft material 90 using sutures threaded through one or more bores 364 formed in the distal apices 363 that overlap with the graft material, as shown in FIG. 22 .
- the proximal apices 361 of the stent 360 are coupled to the coiled member through the slots 376a-376d.
- a first proximal apex 361a may be positioned over the slot 376a, as depicted in FIG. 22 , and the proximal end 141 of the coiled member 140 may be aligned with a coupling member 362 of the first proximal apex 361a.
- proximal apex 361a may be in the form of the suture loop 65, the wire loop 54, or any one of the eyelets 72, 72', 72", 72"' described above, or another suitable connector coupled to the proximal apex 361a, which can be coupled or looped around the proximal end 141 of the coiled member 140.
- the proximal apex 361a may be pushed radially inward and held steady, while the cannula 130 and the coiled member 140 are rotated in a first direction, thereby allowing the coupling member 362 of the proximal apex 361a to be wound in a proximal to distal direction securely about the coiled member 140.
- a second proximal apex 361b may be positioned over the slot 376b and the same process achieved to couple the second proximal apex 361b about the coiled member 140, and this process may be repeated until all of the proximal apices 361 of the stent 360 are coupled to the coiled member 140, through the slots 376a-376d, as shown in FIG. 22 .
- a physician may deploy the stent 360 in the same manner as the explained in FIGS. 4-5 above.
- an outer sheath is retracted to expose at least a portion of the stent 360.
- the cannula 130 may be rotated in a counter-clockwise direction until the coupling member 362 of the first proximal apex 361a is uncoupled from the coiled member 140, i.e., in a reverse manner from which these connectors were coupled to the coiled member 140.
- the stent 360 then may be deployed as shown in FIG. 4 above, and the remainder of the stent-graft may be deployed by further retraction of the outer sheath or actuation of any other devices that are radially constraining the remainder of the stent-graft.
- the protective cage 370 can rotate circumferentially relative to the atraumatic tip 335 and the cannula 130. This allows the orientation of the protective cage 370 and the stent apices 361 to remain generally the same while the cannula 130 and the coiled member 140 are rotated circumferentially during deployment.
- the protective cage 370 encloses the coiled member 140 and reduces the possibility that the coiled member 140 can interfere with, damage, or snag various endovascular, stent or graft structures during manipulation and removal of the delivery device.
- the protective cage 370 also may reduce the likelihood of apices of the stent 360 becoming caught on the coiled member 140 by providing a guided release for the apices.
- the axial orientation of the protective cage 370 may be reversed.
- multiple protective cages 370 may be provided that each enclose a different coiled member.
- an alternative protective cage 370' is similar to the protective cage 370 of FIGS. 21-24 , with like reference numbers representing like parts, except as noted below.
- an enclosing member 390 that surrounds the distal end 142 of the coiled member 140 that is secured to the outer surface 131 of the cannula 130.
- the enclosing member 390 may comprise a first end 391 that is spaced apart from the cannula 130 to accommodate a portion of the coiled member 140, a second end 392 that is secured to the outer surface 131 of the cannula 130, and a tapered region 394 that bridges the different diameters of the first and second ends 391 and 392, as depicted in FIG. 25 .
- the alternative protective cage 370' may comprise a longitudinal region 374', as shown in FIGS.25 , which comprises an intermediate outer diameter dc 3 , which has a dimension less than the first end 371 having the outer diameter dc 1 and greater than the second end 372 having the outer diameter dc 2 ,as depicted in the earlier embodiment of FIG. 24 .
- the longitudinal region 374' further has an inner diameter that is slightly larger than an outer diameter at the first end 391 of the enclosing member 390.
- the enclosing member 390 provides a barrier between a portion of the coiled member 140 and the protective cage 370', which may reduce potential drawbacks arising from direct interference between the distal end 142 of the coiled member 140 and the protective cage 370'.
- an alternative protective cage 370" is similar to the protective cages 370 and 370' above, with a main exception that a plurality of slots 376' has proximal regions 377 that are wider than distal regions 378. The widening of proximal regions 377 of the slots 376' may yield an easier time coupling the stent 360 to the coiled member 140 during loading, and may facilitate release of the stent 360 from the coiled member 140 given less potential interference from the proximal region 377 of the slots 376'.
- proximal apices 361 of the stent 360 can also be modified, e.g., with widened proximal tips, so that they only side out of the protective cage 370" at the proximal region 377 of the slots 376'.
- a stent 360' which is shown in a flattened and compressed state, comprises a series of proximal apices 361' and a series of distal apices 363'. Each of the proximal and distal apices 361' and 363' are separated by a plurality of strut segments 365' and 366', which enable radial expansion from the compressed state shown in FIG. 27 to a generally cylindrical expanded state similar to the stent 60 depicted in FIG. 4 .
- Each of the proximal apices 361' comprises the coupling member 362, as explained with respect to FIG. 22 above, and further comprises an integral barb 367.
- Each of the distal apices 363' comprises a suture bore 364', an imaging marker 368, and an integral barb 369.
- the suture bore 364' overlaps with graft material 90, as depicted in FIG. 22 , and allows suturing of a portion of each distal apex 363' to the graft material 90.
- the imaging marker 368 which is disposed proximal to the suture bore 364', may be aligned precisely with the proximal edge of the graft material 90 to enable precise placement of the proximal edge under an imaging modality.
- the stent 360' may comprise any number 361n' of proximal apices 361', where "n” is the number of apices. In the example of FIG. 27 , "n" is equal to twelve, and each of the twelve proximal apices 361a' through 361n' have identical characteristics, including axial lengths.
- a first proximal apex 361a' is loaded onto the coiled member 40 or 140 in the manner described above via engagement with the coupling member 362, and each subsequent proximal apex 361 is secured to the coiled member 40 or 140 until the final proximal apex 361n' is secured to the coiled member.
- each of the proximal apices 361a' through 361n' comprises a region having a relatively thin strut segment 388, having a notched region 389 formed therein, which advantageously may permit this region of the proximal apex to rotate or bend to facilitate coupling to the coiled member 40 or 140, in the manner described above for the proximal extension segment 74 of FIGS. 6-8 .
- an alternative stent 360" is identical to the stent 360' of FIG. 27 , with the exception that alternative proximal apices 361" comprise different axial lengths relative to one another.
- each of the alternative proximal apices 361" comprises a progressively larger axial length, such that a first proximal apex 361a" comprises the smallest axial length, while the last proximal apex 361n" comprises the greatest axial length.
- Axial lengths of relatively thin strut segments 388' and their associated notched regions 389' may be varied to achieve the length differential between proximal apices 361a" through 361n", which yields a staggered axial positioning of the coupling members 362 of each apex, as shown in FIG. 28 .
- the first proximal apex 361a" is loaded onto the coiled member 40 or 140 in the manner described above via engagement with the coupling member 362, and each subsequent proximal apex 361 is secured to the coiled member 40 or 140 until the final proximal apex 361n" is secured to the coiled member.
- proximal apices 361a" through 361n can therefore be positioned in a uniform radially about the coiled member 40 or 140.
- an alternative atraumatic tip 435 comprises proximal and distal regions 436 and 437, respectively, and a central region 438 disposed therebetween.
- the proximal and distal regions 436 and 437 comprise smaller outer diameters relative to the central region 438, with a first taper allowing for a smooth transition between the proximal region 436 and the central region 438, and a second taper allowing for a smooth transition between the distal region 437 and the central region 438.
- a distal taper 439 is formed at an angle ⁇ relative to the central region 438 and also to the main longitudinal axis of the device.
- the angle ⁇ preferably is minimized to achieve a minimal distance for threading the coupling members 362 of the stents on and off the coiled members 40 and 140.
- a length of a distal face 449 of the atraumatic tip 439 may be greater than the second outer diameter d 2 of the coiled member 140, as illustrated previously.
- a distance x between the proximal end 141 of the coiled member 140 and the distal end of the atraumatic tip 435 may be optimized so that the distance x is just slightly larger than an axial length necessary for coupling the coupling members 362 of the stents on and off the coiled members 40 and 140.
- an alternative atraumatic tip 435' is similar to the atraumatic tip 435 of FIG. 29 , but comprises an alternative distal region 437' having a notched region 440 formed in the distal face of the atraumatic tip 435'.
- the notched region 440 generally follows at least a portion of the profile of the coiled member 140, as shown in FIG. 30 . Further, the distance x between the proximal end 141 of the coiled member and the distal end of the atraumatic tip 435, as explained in FIG, 29 , may be maintained in the embodiment of FIGS. 30-32 , although in an angled manner that corresponds to the angular profile of the coiled member 140, as best seen in FIG. 30 .
- the notched region 440 follows the contours of a longitudinal notch 441 and angled segments 442 and 443, which collectively allow for the separation distance x between the coiled member 140 and the atraumatic tip 435' to be maintained while the proximal end 141 of the coiled member 140 at least partially axially overlaps with the atraumatic tip 435'.
- a first state of the delivery system is shown in FIGS. 30 and 31 , in which the proximal end 141 of the coiled member 140 at least partially axially overlaps with the atraumatic tip 435', may be used during delivery into, and removal from, a patient's vascular system.
- a second state of the delivery system is shown in FIGS.
- the proximal end 141 of the coiled member 140 may occur during deployment as the stent-graft is held longitudinally steady.
- the atraumatic tip 435' may be longitudinally movable relative to the coiled member 140, such that when deployment of the stent-graft is completed, the atraumatic tip 435' may be advanced distally relative to the coiled member 140 until the proximal end 141 of the coiled member is at least partially seated within the notched region 440 of the atraumatic tip 435' for subsequent removal from the vasculature.
- a further alternative atraumatic tip 435" is similar to the atraumatic tips 435 and 435' of FIGS. 29-32 , but comprises an alternative distal region 437" having a notched region 440", and an alternative central region 438" having a channel 450. It is noted that the coiled member 140 is omitted in FIG. 33 for clarity, but is shown in FIG. 35 .
- the notched region 440" may comprise tapered wall portions 441 and 442, which taper in an angled manner radially inward to a valley 443.
- the valley 443 has proximal and distal ends 443a and 443b, respectively, as depicted in FIG. 35 .
- the proximal end 443a of the valley 443 may transition into the channel 450 of the central region 438" of the atraumatic tip 435".
- the channel 450 may be used as a conduit for delivering flushing fluid, which may be provided in a distal to proximal direction through the valley 443 and subsequently through the channel 450.
- the distal end 443b of the valley 443 is disposed in close longitudinal proximity, and preferably slightly proximal to, the proximal end 141 of the coiled member 140.
- the distance between the proximal end 141 of the coiled member 140 and the distal end of the atraumatic tip 435" remains such that there is sufficient space for the coupling members 362 of stents to be released from the coiled member 140, as described above.
- the proximal end 141 of the coiled member 140 may terminate at a circumferential location slightly offset from the center of the valley 443. For example, in FIG.
- the proximal end 141 of the coiled member 140 is shown slightly above the center of the valley 443, and about even with the tapered wall portion 441. In this manner, the center of the valley 443 will be aligned precisely with the coupling members 362 as they exit from engagement with the proximal end 141 of the coiled member 140.
- the valley 443 may significantly reduce the likelihood of the atraumatic tip 435" becoming caught on a radially deployed coupling member 362.
- the delivery system including the atraumatic tip 435" will be retracted distally outside of the patient, and during the phase of initial retraction, the valley 443 helps provide a ramp-like feature to ensure that the deployed coupling member 362 of the stents will not become caught on the atraumatic tip 435" upon its removal.
- the valley 443 of the notched region 440" also provides a ramp-like pathway for the coupling members 362 to follow as they move radially outward from the proximal end 141 of the coiled member 140 towards a vessel wall. Accordingly, the provision of the valley 443 may significantly reduce the likelihood of the coupling members 362 of the stents becoming caught on the atraumatic tip 435" during deployment, in addition to after deployment.
Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Physics & Mathematics (AREA)
- Optics & Photonics (AREA)
- Prostheses (AREA)
Abstract
Description
- The present embodiments relate generally to apparatus and methods for treating medical conditions, and more specifically, to systems and methods for deploying a portion of a stent using at least one coiled member.
- Stents may be inserted into an anatomical vessel or duct for various purposes. Stents may maintain or restore patency in a formerly blocked or constricted passageway, for example, following a balloon angioplasty procedure. Other stents may be used for different procedures, for example, stents placed in or about a graft have been used to hold the graft in an open configuration to treat an aneurysm. Additionally, stents coupled to one or both ends of a graft may extend proximally or distally away from the graft to engage a healthy portion of a vessel wall away from a diseased portion of an aneurysm to provide endovascular graft fixation.
- Stents may be either self-expanding or balloon-expandable, or they can have characteristics of both types of stents. Self-expanding stents may be delivered to a target site in a compressed configuration and subsequently expanded by removing a delivery sheath, removing trigger wires and/or releasing diameter reducing ties. With self-expanding stents, the stents expand primarily based on their own expansive force without the need for further mechanical expansion. In a stent made of a shape-memory alloy such as Nitinol, the shape memory alloy may be employed to cause the stent to return to a predetermined configuration upon removal of the sheath or other device maintaining the stent in its predeployment configuration.
- When trigger wires are used as a deployment control mechanism, the trigger wires may releasably couple the proximal and/or distal ends of a stent or stent-graft to a delivery catheter. Typically, one or more trigger wires are looped through a portion of the stent near a vertex of the stent. For example, trigger wires may be used to restrain a "Z-stent" or Gianturco stent comprising a series of substantially straight segments interconnected by a series of bent segments. The trigger wires may be disposed through, and pull upon, the bent segments to pull the stent closely against the delivery catheter.
- Trigger wires also may be used in conjunction with different stent designs, such as cannula-cut stents having relatively acute or pointed bends. The designs of cannula-cut stents may facilitate compression of the stent to a relatively small delivery profile due to the tight bends of the apices. With such stents, the trigger wires may be looped around one or more vertices formed beneath the proximal and/or distal apices, e.g., a location where an individual apex splits into two separate strut segments.
- If trigger wires are threaded through the vertices of such cannula-cut stents, the trigger wires may become crimped at the vertices during compression of the stent to a reduced diameter delivery profile. If the trigger wires are crimped between the strut segments, the trigger wires and/or stent segments may become damaged during delivery, particularly for nickel-titanium stents that may be sensitive to surface imperfections. Furthermore, when compressing a cannula-cut stent having relatively acute bends to a significantly reduced radial profile, barbs disposed near the apices of the stent may become entangled with the stent struts and/or the trigger wires. Still further, in some instance, trigger wires may require a relatively high deployment force when being retracted, and the provision of multiple trigger wires may add to the profile of the delivery system.
- The present invention seeks to provide an improved system and method for deploying a stent.
- According to an aspect of the present invention, there is provided a system for deploying a stent as specified in claim 1.
- The preferred embodiments provide systems and methods for deploying at least a portion of a stent. In one embodiment, the system comprises a cannula having an outer surface, and at least one coiled member having proximal and distal ends and a plurality of turns disposed therebetween. One of the proximal and distal ends of the coiled member is secured to the outer surface of the cannula, and the other of the proximal and distal ends of the coiled member is unsecured relative to the outer surface of the cannula. A portion of a stent is looped around the unsecured end of the coiled member and disposed within spacing between adjacent turns of the coiled member. Rotation of the cannula subsequently causes the portion of the stent to disengage from the coiled member.
- In one embodiment, the distal end of the coiled member is secured to the outer surface of the cannula and the proximal end of the coiled member is unsecured relative to the outer surface of the cannula. In this example, a portion of the stent is looped around the proximal end of the coiled member and further is disposed within spacing between adjacent proximal turns of the coiled member in the delivery state.
- In another embodiment, the proximal end of the coiled member is secured to the outer surface of the cannula and the distal end of the coiled member is unsecured relative to the outer surface of the cannula, and a portion of the stent is looped around the distal end of the coiled member and further is disposed within spacing between adjacent distal turns of the coiled member in the delivery state. In this embodiment, a distal series of turns of the coiled member may be spaced apart further from one another relative to spacing between a proximal series of turns. Further, a first diameter at the proximal end of the coiled member permits attachment to the outer surface of the cannula, while a second diameter at the distal end of the coiled member is greater than the first diameter and there is a gap disposed between the distal end of the coiled member and the outer surface of the cannula.
- In one embodiment, first and second coiled members are provided and are longitudinally spaced apart from one another along a length of the cannula. In this example, the first coiled member engages a first stent portion in the delivery state and the second coiled member engages a second stent portion in the delivery state. The first coiled member may comprise a greater number of turns that are unsecured relative to the cannula than the second coiled member, thereby enabling the second stent portion to disengage from the second coiled member before the first stent portion disengages from the first coiled member when the cannula is rotated in a uniform direction. In various embodiments, a ring portion may extend from the stent and is dimensioned to be accommodated within the spacing between adjacent turns of the coiled member in the delivery state.
- In another embodiment, at least one suture loop comprises a proximal region that is coupled to the cannula, and a distal region that is retained within one of the plurality of turns of the coiled member in the delivery state. The suture loop is further coupled around a portion of a stent in the delivery state. Rotation of the cannula causes longitudinal movement of the distal region of the suture loop relative to the proximal region of the suture loop, thereby varying the slack in the suture loop and varying expansion of the portion of the stent that is coupled to the suture loop.
- A protective cage may encircle the coiled member. In one embodiment, the protective cage is circumferentially rotatable relative to the cannula. An atraumatic tip may be coupled to the cannula, such that at least a portion of the atraumatic tip is disposed beneath the protective cage, and the protective cage can rotate circumferentially relative to the atraumatic tip and the cannula. A distal stop member may be coupled to the cannula and positioned adjacent to a distal end of the protective cage. The distal stop member allows the protective cage to rotate relative to the cannula, but prevents the protective cage from sliding distally over the cannula.
- The protective cage may comprise a plurality of struts separated by a plurality of slots. A portion of the stent that is temporarily coupled to the coiled member extends through one of the plurality of slots. In one embodiment, each of the plurality of struts and each of the plurality of slots are generally parallel to each other in a direction running along a longitudinal axis of the apparatus. Optionally, at least one of the plurality of slots has proximal and distal regions and a width at the proximal region is greater than a width at the distal region.
- According to another aspect of the present invention there is provided a system for deploying at least a portion of a stent, the system comprising: a rotatable cannula having an outer surface; at least one coiled member having proximal and distal ends and a plurality of turns disposed therebetween, where the distal end of the coiled member is secured to the outer surface of the cannula, and the proximal end of the coiled member is unsecured relative to the outer surface of the cannula; a stent disposed on the cannula; and at least one suture loop comprising a proximal region that is coupled to the cannula, and a distal region that is retained within one of the plurality of turns of the coiled member, where the suture loop is further coupled around a portion of a stent, and where rotation of the cannula causes longitudinal movement of the distal region of the suture loop relative to the proximal region of the suture loop, thereby varying the slack in the suture loop and varying expansion of the portion of the stent that is coupled to the suture loop.
- Preferably, the system comprises a swivel that is coupled to the cannula, where the proximal region of the suture loop is coupled to the swivel.
- This aspect can include the elements and features of the other embodiments disclosed herein.
- Other systems, methods, features and advantages of the invention will be, or will become, apparent to one with skill in the art upon examination of the following figures and detailed description. It is intended that all such additional systems, methods, features and advantages be within the scope of the invention, and be encompassed by the following claims.
- Embodiments of the present invention are described below, by way of example only, with reference to the accompanying drawings, in which:
-
FIG. 1 is a side view of a first embodiment of an apparatus for deploying a portion of a stent using at least one coiled member. -
FIG. 2 is an enlarged view of the coiled member ofFIG. 1 . -
FIG. 3 depicts an exemplary stent-graft having a portion that may be deployed using the coiled member ofFIGS. 1-2 . -
FIGS. 4-5 are side views depicting coupling of the stent-graft ofFIG. 3 to the apparatus ofFIGS. 1-2 . -
FIG. 6 is a perspective view of a proximal apex of a stent that may be coupled to a coiled member. -
FIGS. 7-8 are side views depicting twisting of a portion of the proximal apex of the stent ofFIG. 6 . -
FIG. 9 is a perspective view of an alternative proximal apex of a stent that may be coupled to a coiled member. -
FIGS. 10-11 are side views depicting a further alternative proximal apex of a stent that may be coupled to a coiled member. -
FIG. 12 is a side view of further alternative proximal apices of a stent that may be coupled to a coiled member. -
FIG. 13 is a side view of yet further alternative proximal apices of a stent that may be coupled to a coiled member. -
FIG. 14 is a side view of an alternative embodiment of an apparatus for deploying stent portions using first and second coiled members. -
FIG. 15 is a side view depicting coupling of a stent-graft to the apparatus ofFIG. 14 . -
FIG. 16 is a side view of a portion of a stent suitable for use as an inner stent of the stent-graft ofFIG. 15 . -
FIG. 17 is a side view of a portion of an alternative stent suitable for use as an inner stent of the stent-graft ofFIG. 15 . -
FIG. 18 is a side view of a further alternative embodiment of an apparatus for deploying stent portions using first and second coiled members. -
FIGS. 19-20 are side views of yet a further alternative embodiment of an apparatus for deploying a portion of a stent using at least one coiled member in a delivery state and a partially deployed state, respectively. -
FIG. 21 is a side view of an embodiment of a protective cage that may be used in conjunction with the coiled member. -
FIG. 22 is a side view depicting a portion of a stent used with the apparatus ofFIG. 21 . -
FIGS. 23A-23C are, respectively, cross-sectional views of the protective cage ofFIG.21 as taken along lines A--A, B--B and C--C. -
FIG. 24 is a side-sectional view of the protective cage ofFIG. 21 . -
FIG. 25 is a side view of an alternative protective cage. -
FIG. 26 is a side view of a further alternative protective cage. -
FIG. 27 is a side view of a stent, shown in a flattened and compressed state, which is suitable for deployment using a coiled member. -
FIG. 28 is a side view of an alternative stent, shown in a flattened and compressed state, which is suitable for deployment using a coiled member. -
FIG. 29 is a side view of an alternative atraumatic tip and coiled member arrangement. -
FIG. 30 is a side view of a further alternative atraumatic tip and coiled member arrangement. -
FIGS. 31-32 are, respectively, images depicting first and second states of the coiled member ofFIG. 30 . -
FIGS. 33-35 are, respectively, a side view of a further alternative atraumatic tip for use with a coiled member arrangement, and end view ofFIG. 33 , and a side illustration of the atraumatic tip ofFIGS. 33-34 with a coiled member disposed in the vicinity. - The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.
- In the present application, the term "proximal" refers to a direction that is generally closest to the heart during a medical procedure, while the term "distal" refers to a direction that is furthest from the heart during a medical procedure.
- Referring to
FIGS. 1-2 , a first embodiment of anapparatus 20 is shown for deploying a portion of a stent using at least one coiled member. Theapparatus 20 generally comprises acannula 30 having anouter surface 31, and at least onecoiled member 40 having a region that is secured to theouter surface 31 of thecannula 30. - The
cannula 30 may be incorporated as part of a broader stent or stent-graft delivery system, and may span a longitudinal length in which a distal segment extends outside of a patient's body, and aproximal segment 34, including the coiledmember 40, is delivered towards a target site inside of a patient's body. Thecannula 30 may be used as an inner cannula, to the extent that one or more outer cannulas or sheaths are disposed coaxially over thecannula 30. For example, a stent-graft may be disposed over an exterior surface of thecannula 30 and within one or more outer cannulas or sheaths, thereby encompassing the stent-graft during a delivery stage. - The
cannula 30 may comprise a tubular member having a lumen sized to allow thecannula 30 to be advanced over a wire guide during delivery. A proximal region of thecannula 30 may be integrally formed with, or externally coupled to, anatraumatic tip 35. Theatraumatic tip 35 may comprise proximal anddistal regions central region 38 disposed therebetween. The proximal anddistal regions central region 38, with a first taper allowing for a smooth transition between theproximal region 36 and thecentral region 38, and a second taper allowing for a smooth transition between thedistal region 37 and thecentral region 38. - The coiled
member 40 comprises aproximal end 41, adistal end 42, and a plurality ofturns 43 disposed therebetween, as shown inFIGS. 1-2 . In this non-limiting example,theproximal end 41 of the coiledmember 40 is secured to theouter surface 31 of thecannula 30 using a suitable mechanism, such as a solder, weld, mechanical attachment, friction fit, crimp, or combination of these or other techniques and mechanisms. Accordingly, theproximal end 41 of the coiledmember 40 cannot move relative to theouter surface 31 of thecannula 30. Theproximal end 41 of the coiledmember 40 comprises a first diameter d1, which may be approximately the same diameter, or slightly greater than, an outer diameter of thecannula 30. - The
distal end 42 of the coiledmember 40 is unsecured relative to theouter surface 31 of thecannula 30, as shown inFIGS. 1-2 . Thedistal end 42 of the coiledmember 40 may comprise a second diameter d2, which is greater than the first diameter d1 of theproximal end 41 of the coiledmember 40. There is a separation orgap 44 between thedistal end 42 of the coiledmember 40 and theouter surface 31 of thecannula 30, as best seen inFIG. 2 . - The plurality of
turns 43 are divided into a proximal series ofturns 43a, which have the first diameter d1, and a distal series ofturns 43b, which have the second diameter d2. The proximal series ofturns 43a may be disposed in close proximity or abutting one another, as depicted inFIG. 2 . By contrast, the distal series ofturns 43b may be spaced apart from one another a greater distance than the proximal series ofturns 43a. InFIG. 2 , the distal series ofturns 43b are spaced apart a predetermined distance denoted by spacing 45. As will be described further inFIGS. 4-5 below, a portion of astent 60 may be coupled to at least one of the distal series ofturns 43b, and secured within the spacing 45 between adjacent distal turns. - The exemplary coiled
member 40 may be formed from stainless steel, Nitinol, titanium, or other suitable biocompatible materials. If manufactured from Nitinol, the unsecured end of the coiled member may be heat-set so that it contracts around theouter surface 31 of thecannula 30 when disposed within the body, thereby reducing the likelihood of the coiledmember 40 snagging thestent 60 or other components. In one example, the coiledmember 40 is formed from a material that has radiopaque properties. - Referring now to
FIG. 3 , an exemplary stent-graft 50, having a proximally-locatedstent 60 coupled to agraft material 90, may be deployed in a controlled manner using the coiledmember 40 ofFIGS. 1-2 , as shown further in the exemplary coupling sequence ofFIGS. 4-5 below. In this non-limiting embodiment, thestent 60 may be manufactured from a continuous cylinder into which a pattern may be cut by a laser or by chemical etching to produce slits in the wall of the cylinder. The resulting structure may then be heat set to give it a desired final configuration. As shown inFIG. 3 , the final configuration may include a shape having a series of proximal apices and a series of distal apices. Aproximal end 62 of thestent 60 may comprise multiple adjacentproximal apices distal end 64 of thestent 60 may comprise multiple adjacentdistal apices FIG. 3 . - In
FIG. 3 , at least one pair of adjacent,proximal apices FIG. 3 , a firstproximal apex 62a may comprise anend region 70 having abore 71 formed therein, wherein thebore 71 is configured to receive asuture loop 65, as explained further below. A second, adjacentproximal apex 62b may comprise anend region 75 having anintegral barb 77 formed therein, as shown inFIG. 3 . Thebarb 77 may be formed by laser cutting a desired barb shape into theend regions 75. A slit 76 therefore is formed into eachend region 75 after the desired barb shape is formed, as shown inFIG. 3 . Once the desired barb shape is cut, a main body of thebarb 77 may be bent in a radially outward direction with respect to theend region 75. The angle may comprise any acute angle, or alternatively may be substantially orthogonal or obtuse. If desired, thebarb 77 may be sharpened, for example, by grinding the tip of the barb, to facilitate engagement at a target tissue site. - Referring still to
FIG. 3 , thestent 60 may comprise at least one strut segment disposed between the proximal and distal apices. For example, multiple angled strut segments may be disposed between a firstproximal apex 62a and a correspondingdistal apex 64a, and an identical set of angled strut segments may be disposed between an adjacent, secondproximal apex 62b and a correspondingdistal apex 64b. By way of example, a firstproximal apex 62a extends distally and splits into first and secondangled strut segments proximal vertex 78, as shown inFIG. 3 . In a compressed state, the first and secondangled strut segments distal apex angled strut segments distal vertex 79. A firstangled strut segments 67 may meet with an adjacent secondangled strut segment 68, thereby forming atransition region 80. In this manner, thestent 60 may be formed into a continuous, generally cylindrical shape, as shown inFIG. 3 . - Expansion of the
stent 60 is at least partly provided by theangled strut segments 67 30 and 68, which may be substantially parallel to one another in a compressed state, but may tend to bow outward away from one another in the expanded state shown inFIG. 3 . Thestent 60 may be formed from any suitable material, such as a laser-cut Nitinol cannula. If manufactured from Nitinol, thestent 60 may be inclined to assume the expanded state shown inFIG. 3 upon removal of a delivery sheath or engagement with the coiledmember 40, as explained inFIGS. 4-5 below. - Each
transition region 80 may comprise a larger surface area relative to the angled segments, since the transition regions are composed substantially of multiple differentangled segments stent 60 may comprise at least onebarb 82 disposed in at least one of thetransition regions 80. Thebarb 82 may be formed integrally, as part of the strut, or may comprise an external barb that is adhered to a surface of thetransition regions 80. As shown inFIG. 3 , multipleintegral barbs 82 are provided. Like thebarbs 77 noted above, thebarbs 82 may be formed by laser cutting a desired barb shape into thetransition regions 80. A slit 81 therefore is formed into thetransition region 80 after the desired barb shape is formed, as shown inFIG. 3 . Since thetransition regions 80 may comprise an increased surface area relative to other regions of thestent 60, it may be easier to perforate portions of thetransition regions 80 without adversely affecting the structural integrity of the stent. Once the desired barb shape is cut, a main body of thebarb 82 may be bent in an outward direction at any angle with respect to thetransition region 80 and optionally may be sharpened to facilitate engagement at a target tissue site. - Each of the
distal apices FIG. 3 . Thedistal end 64 of thestent 60 may be coupled to aproximal end 92 of thegraft material 90. Thedistal apices stent 80. In this manner, thestent 60 may be used as an attachment stent for endovascular graft fixation. For example, thegraft material 90 may overlap with an aneurysm to seal off fluid flow into the aneurysm, while theproximal end 62 of thestent 60 may extend in a proximal direction away from the graft material, e.g., to engage a healthy portion of a vessel wall away from a diseased portion of the aneurysm. As will be apparent, one or more additional stents may be coupled to an inner or outer surface of thegraft material 90, i.e., at a location distal to thestent 60, to help maintain patency throughout the graft material. While multiple exemplary zig-zag stents 95 are shown coupled to thegraft material 90 between the proximal anddistal ends graft material 90 inFIGS. 4-5 , it will be apparent than any shape of stent may be used, and such stents may be coupled to either the inner or outer surfaces of thegraft material 90. - The
stent 60 has a reduced diameter delivery state so that it may be advanced to a target location within a vessel or duct. Thestent 60 also has an expanded deployed state to apply a radially outward force upon at least a portion of a vessel or duct, e.g., to maintain patency within a passageway, or to hold open the lumen of a graft. In the expanded state, fluid flow is allowed through a central lumen of thestent 60. Further, the struts of thestent 60 may comprise a substantially flat wire profile or may comprise a rounded profile. As best seen inFIG. 3 , the struts of thestent 60 generally comprise a flat wire profile. - The
stent 60 may be manufactured from a super-elastic material. Solely by way of example, the super-elastic material may comprise a shape-memory alloy, such as a nickel titanium alloy (Nitinol). If thestent 60 comprises a self-expanding material such as Nitinol, the stent may be heat-set into the desired expanded state, whereby thestent 60 can assume a relaxed configuration in which it assumes the preconfigured first expanded inner diameter upon application of a certain cold or hot medium. Alternatively, thestent 60 may be made from other metals and alloys that allow thestent 60 to return to its original, expanded configuration upon deployment, without inducing a permanent strain on the material due to compression. Solely by way of example, thestent 60 may comprise other materials such as stainless steel, cobalt-chrome alloys, amorphous metals, tantalum, platinum, gold and titanium. Thestent 60 also may be made from non-metallic materials, such as thermoplastics and other polymers. - While one
exemplary stent 60 is shown inFIG. 3 and described inFIGS. 4-5 below, various alternative stent configurations may be used in conjunction with the coiledmember 40 ofFIGS. 1-2 . Moreover, the stent may be deployed alone, or as part of a stent-graft system, as depicted herein. - Referring now to
FIGS. 4-5 , an exemplary coupling of the stent-graft 50 ofFIG. 3 to the deployment apparatus ofFIGS. 1-2 is shown and described. The stent-graft 50 has an uncoupled state in which the stent-graft 50 is positioned coaxially over thecannula 30 with theproximal end 62 of thestent 60 in longitudinal proximity relative to thedistal end 42 of the coiledmember 40, as shown inFIG. 4 . During assembly, thesuture loops 65 that are coupled to theproximal apices 62a of thestent 60 are threaded around thedistal end 42 of the coiledmember 40 one at a time, preferably until all of thesuture loops 65 are coupled to the coiledmember 40. Such coupling may be achieved by rotating thecannula 30 in a clockwise direction until theproximal end 62 of thestent 60 is sufficiently compressed in a radially inward direction, as depicted inFIG. 5 . It should be noted that thegap 44 between thedistal end 42 of the coiledmember 40 and theouter surface 31 of thecannula 30 permits positioning of thesuture loops 65 around the distal series ofturns 43b. - The
suture loops 65 are further accommodated within the spacing 45 between the distal series ofturns 43b. Thesuture loops 65 preferably are coupled to the coiledmember 40 in a manner in which at least onesuture loop 65 is positioned around at least one full turn of the distal series ofturns 43b, and preferably around at least 1.5 turns at thedistal end 42 of the coiledmember 40, thereby reducing the likelihood of inadvertent uncoupling of thesuture loops 65 from the coiledmember 40. - The coupling shown in
FIG. 5 secures thestent 60 to thecannula 30 via the coiledmember 40 in a manner that may subsequently facilitate insertion of the subassembly comprising thecannula 30 and the stent-graft 50 into an outer sheath. As will be apparent, the outer sheath is configured to radially restrain other regions of the stent-graft 50 for delivery to a target site within a patient's anatomy. - In this embodiment, the
suture loops 65 are coupled to every other proximal apex 62a to restrain thestent 60 during delivery. Thesuture loops 65 are not coupled to the secondproximal apices 62b, which comprise thebarbs 77. By restraining the alternatingproximal apices 62a using thesuture loops 65 coupled to the coiledmember 40, the adjacent secondproximal apices 62b also may be indirectly pulled in a radially inward direction during delivery. The configuration of thestent 60, and in particular theangled segments transition regions 80, facilitates the indirect compression of the adjacent secondproximal apices 62b. Since only selected ones of the proximal apices are restrained during delivery, the number ofsuture loops 65 may be reduced. Moreover, since thebarbs 77 are only disposed on every other apex, barb entanglement may be reduced or eliminated. - An introducer, similar to that described in
PCT application WO98/53761 graft 50.PCT application WO98/53761 graft 50. Rather, thecannulas coiled members graft 50 being positioned coaxially between thecannula 30 and the outer sheath. A mechanism, such as a pin vise, may be employed to prevent inadvertent rotation of thecannula 30 prior to the intended rotation as described in the present application. - In the present embodiments, a wire guide may be advanced to the target site, and the
cannula 30 may be advanced over the wire guide to position theapparatus 20 at the desired location in proximity to the target site, with theatraumatic tip 35 reducing the likelihood of injury to bodily passageways during delivery. The outer sheath is disposed over thecannula 30 and the stent-graft 50 during insertion to the target site. Upon proper positioning at the target site using a desired imaging modality, the outer sheath is then retracted to expose at least a portion of thestent 60. - When the
stent 60 is at least partially exposed, and it is desirable to deploy theproximal end 62 of thestent 60, thecannula 30 may be rotated in a counter-clockwise direction until thesuture loops 65 are uncoupled from the coiledmember 40, i.e., in a reverse manner from which thesuture loops 65 were coupled to the coiledmember 40. Thestent 60 then may be deployed as shown inFIG. 4 , and the remainder of the stent-graft 50 may be deployed by further retraction of the outer sheath or actuation of any other devices that are radially constraining the remainder of the stent-graft 50. As will be explained further inFIGS. 14-15 below, a plurality of coiled members may be used to selectively deploy multiple stent portions of the stent-graft 60. - Advantageously, the
proximal end 62 of thestent 60 is radially restrained without the use of convention trigger wires that span a full longitudinal length of the delivery system. Accordingly, the radial profile of the delivery system may be reduced without the provision of multiple trigger wires and one or more associated sleeves to house the trigger wires, thereby reducing packing density of the system. Moreover, deployment may be simplified as reduced deployment forces are expected to be needed relative to the use of conventional trigger wires. - As a further advantage, deployment of the
stent 50 using theapparatus 20 comprising at least onecoiled member 40 may allow for more precise positioning of thestent 50. In particular, deployment using the coiledmember 40 may provide a more controlled unwinding of the associated portion of thestent 50, whereas the release of conventional trigger wires may require higher deployment forces that can cause a portion of the stent to jump longitudinally, thereby potentially deploying the stent offset from the intended target site. - Referring now to
FIGS. 6-8 , a portion of an alternative stent 60' is described for use with theapparatus 20 comprising at least onecoiled member 40 as described inFIGS. 1-2 andFIGS. 4-5 . The alternative stent 60' is similar to thestent 60 ofFIG. 3 , with a main exception that an alternative proximal end 62' comprises at least one alternative proximal apex 62b' having an region comprising aneyelet 72. - The
eyelet 72 may be formed within aring portion 73 that is disposed at the proximal end of aproximal extension segment 74. Theproximal extension segment 74 extends in a proximal direction away from theend region 75 having theintegral barb 77, as shown inFIGS. 6-8 . - In accordance with one embodiment, the
ring portion 73 and theproximal extension segment 74 comprise a wall thickness that is less than a wall thickness of theend region 75 having theintegral barb 77, as best seen inFIG. 6 . Advantageously, the reduced wall thickness of thering portion 73 and theproximal extension segment 74 allows at least thering portion 73 to twist in a circumferential direction to facilitate loading of the proximal apex 62' around the coiledmember 40. In the example shown, thering portion 73 twists in a circumferential direction about 90 degrees between a first state shown inFIG. 7 and a second state shown inFIG. 8 . As will be apparent, thering portion 73 may twist greater or less than 90 degrees, and the exemplary depiction between the states ofFIGS. 7 and 8 is not intended to be limiting. Moreover, at least a portion of theproximal extension segment 74 may twist in the circumferential direction. Theproximal extension segment 74 may twist a greater amount proximally since it is further from attachment from theend region 75 having the greater wall thickness. - As another advantage, the
proximal extension segment 74 provides longitudinal separation of thering portion 73 housing theeyelet 72 from theend region 75 having theintegral barb 77. Accordingly, when theeyelet 72 is threaded around the coiledmember 40, theproximal extension segment 74 provides a longitudinal spacing that reduces the likelihood of entanglement between thecoiled member 40 and theintegral barb 77 of theend region 75. - In the example of
FIGS. 6-8 , thering portion 73 and theproximal extension segment 74 may be integrally formed with theend region 75. If the stent 60' is formed from Nitinol or a similar material, the superelastic properties of such material can facilitate circumferential twisting of thering portion 73 between the first and second states shown inFIGS. 7 and 8 . - The alternative proximal apex 62b' shown in
FIGS. 6-8 may be provided on each and every proximal apex of the stent 60'. Alternatively, the alternative proximal apex 62b' may be provided on fewer than all of the proximal apices of the stent 60', and the remaining proximal apices may be provided with only barbs, e.g., as depicted by theproximal apices 62b inFIG. 3 above, or the proximal apices may comprise other features. - Referring now to
FIG. 9 , a furtheralternative stent 60" has aproximal end 62" having at least oneproximal apex 62b", which is similar to theproximal apex 62b' ofFIGS. 6-8 ,with a main exception that analternative ring portion 73' having an eyelet 72' and proximal extension segment 74' are formed separately from theend region 75. In this example, abore 83 is formed at a proximal edge of theend region 75 at a location spaced proximally away from theintegral barb 77, as shown inFIG. 9 . Adistal portion 84 of the proximal extension segment 74' is sized to be received within thebore 83 of theend region 75. Thedistal portion 84 of the proximal extension segment 74' then may be secured, e.g., using a solder or weld, within thebore 83 of theend region 75, forming theproximal apex 62b" shown inFIG. 9 . In this alternative embodiment, thering portion 73' and the proximal extension segment 74' optionally may be formed of a different material, such as a more flexible material, relative to the remainder of thestent 60". - Referring now to
FIGS. 10-11 , a furtheralternative stent 60"' has aproximal end 62"' having at least oneproximal apex 62b"'. In this example, awire loop 54 is coupled to theend region 75 having theintegral barb 77 by winding thewire loop 54 around a portion of theslit 76 formed into theend region 75. Thewire loop 54 may be wound securely by placing afirst loop portion 55 under theend region 75, then around thebarb 77, and folding over proximally through theslot 76, as shown inFIG. 10 . Then, asecond loop portion 56, which preferably is larger than thefirst loop portion 55 and disposed primarily proximally to thefirst loop portion 55, may be pulled in a proximal direction as depicted inFIG. 11 . By pulling thesecond loop portion 56 proximally, thefirst loop portion 55 shortens and tightens around theend region 75, as shown inFIG. 11 . Optionally, a solder may be applied to hold thefirst loop portion 55 tightly around theend region 75. The resulting structure comprises thesecond loop portion 56 extending proximally away from theend region 75 in a manner such that thesecond loop portion 56 can be wound around the coiledmember 40 ofFIGS. 1-2 and4-5 , in the manner generally described above with respect to thesuture loop 65. - Advantageously, the
wire loop 54 may be formed from a flexible material. If formed from Nitinol or a similar material, the superelastic properties of such material can facilitate circumferential twisting of thesecond loop portion 56 between the first and second states shown inFIGS. 7 and 8 , thereby facilitating engagement around the coiledmember 40. Moreover, thewire loop 54 may be considerably thinner than theend region 75 to facilitate engagement around the coiledmember 40, e.g., by permitting twisting of thesecond loop portion 56 as needed during loading, and also by having a reduced thickness wire loop that can easily fit within thegap 44 and spacing 45 around the coiledmember 40, as explained above. - Referring now to
FIGS. 12-13 , further alternative proximal ends of exemplary stents, suitable for deployment via theapparatus 20 having the coiledmember 40, are shown and described. InFIG. 12 , an alternative proximal region of a stent comprises alternatingproximal apices 62a' and 62b. Theproximal apices 62b are substantially identical to theproximal apices 62b described above inFIG. 3 . However, theproximal apices 62a' differ from theproximal apices 62a ofFIG. 3 by replacing theend region 70 having thebore 71 that is configured to receive thesuture loop 65 with analternative end region 70" that has anintegral eyelet 72" within aring portion 73". In the embodiment ofFIG. 12 , thering portion 73" may be disposed at the proximal end of theend region 70". Thering portion 73" then may be cut into this pattern in a manner integral with the remainder of the stent, e.g., by laser cutting a cannula. Thering portion 73" subsequently may be bent radially inward at a desired angle, such as between 45 and 90 degrees, and then heat-set into the bent position to facilitate engagement with the coiledmember 40 described above. - The embodiment of
FIG. 13 is similar toFIG. 12 , with the exception that alternativeproximal apices 62a" compriseend regions 70"' havingring portions 73"' that house eyelets 72"' that are positioned further distally, i.e., spaced apart from proximal end of theend regions 70"'. As will be apparent, the eyelet positioning may be modified without departing from the spirit of the present embodiments. Moreover, in certain embodiments, the ring portions housing the eyelet may be disposed further proximally than shown inFIG. 12 such that the ring portions extend proximally beyond then end of the adjacentproximal apices 62b. - Referring now to
FIGS. 14-15 , analternative apparatus 120 is shown for deploying a plurality of stent portions using a plurality of coiled members. Theapparatus 120 is similar to theapparatus 20 ofFIGS. 1-2 andFIGS. 4-5 , with main exceptions noted below. In particular, theapparatus 120 ofFIGS. 14-15 comprises a firstcoiled member 140 and a secondcoiled member 180, which are coupled to anouter surface 131 of acannula 130 at locations that are longitudinally spaced apart from one another. - The first
coiled member 140 comprises aproximal end 141, adistal end 142, and a plurality ofturns 143 disposed therebetween. In this embodiment, thedistal end 142 of the firstcoiled member 140 is secured to theouter surface 131 of thecannula 130 using a suitable mechanism, such as a solder, weld, mechanical attachment, friction fit, crimp, or combination of these or other techniques and mechanisms, as generally described above. Theproximal end 141 of the firstcoiled member 140 is unsecured relative to theouter surface 131 of thecannula 130 at a location just proximal to anatraumatic tip 135, as shown inFIG. 14 . Theproximal end 141 of the firstcoiled member 140 preferably comprises the second diameter d2, shown inFIG. 2 above, and provides the same separation orgap 44 described inFIG. 2 above between theproximal end 141 of the firstcoiled member 140 and theouter surface 131 of thecannula 130. - Similarly, the second
coiled member 180 comprises aproximal end 181, adistal end 182, and a plurality ofturns 183 disposed therebetween. Thedistal end 182 of the secondcoiled member 180 is secured to theouter surface 131 of thecannula 130, as generally described above, at a location distally spaced apart from the firstcoiled member 140, as shown inFIGS. 14-15 . Theproximal end 181 of the secondcoiled member 180 is unsecured relative to theouter surface 131 of thecannula 130, as shown inFIG. 14 . Theproximal end 181 of the secondcoiled member 180 preferably comprises the second diameter d2 and provides the same separation orgap 44 between theproximal end 181 of the secondcoiled member 180 and theouter surface 131 of thecannula 130. - During delivery, the first
coiled member 140 is coupled to a first portion of the stent-graft 50', while the secondcoiled member 180 is coupled to a second portion of the stent-graft 50'. In this example, the firstcoiled member 140 is coupled to thesuture loops 65 that are coupled to theproximal apices 62a of thestent 60, as explained inFIGS. 3-5 above, while the secondcoiled member 180 is coupled to a central region of thegraft material 90. In particular, at least oneinner stent 195 is coupled to an inner surface of thegraft material 90 and configured to engage thecoiled member 180, in the manner generally described above with respect toFIGS. 1-5 . It should be noted that while the secondcoiled member 180 and a portion of thecannula 130 is disposed within thegraft material 90 inFIG. 15 , for illustrative purposes these components are shown in solid, not dashed, lines. Advantageously, the first and secondcoiled members - Moreover, in the example of
FIGS. 14-15 , the firstcoiled member 140 has a greater number of proximal turns 143a that are spaced apart further relative todistal turns 143b to accommodate a portion of the stent-graft 50', relative to the number of proximal turns 183a that are spaced apart further relative todistal turns 183b on the secondcoiled member 180. Accordingly, by varying the number of proximally spaced-apart turns 143a and 183a on the first and secondcoiled members coiled member FIGS. 14-15 , since the secondcoiled member 180 has fewer proximal turns 183a that are spaced apart to accommodate thestent 195, then thestent 195 will disengage from theproximal turns 183a relatively fast to deploy the central portion of the stent-graft 50' shortly after thecannula 130 is rotated. Subsequently, as thecannula 130 is rotated further, thesuture loops 65 coupled to theproximal apices 62a of thestent 60 will disengage from the greater number ofproximal turns 143a of the firstcoiled member 140 to deploy theproximal stent 60, after the central portion of the stent-graft 50 has been deployed. - As will be appreciated, any number of coiled members may be provided along the length of the cannula to selectively control deployment of any number of corresponding regions along a stent or stent-graft. By varying the number of spaced-apart turns, different portions of the stent or stent-graft may be selectively deployed before other portions simply by continuing to rotate a single cannula comprising the multiple coiled members.
- Moreover, the portions of the stent-graft 50' that are coupled to the first and second
coiled members cannula 130 in a first direction may cause the portions of the stent-graft 50' to expand at least partially radially outward, while rotation in the opposing direction may cause the portions of the stent-graft 50' to contract radially inward, and this may be repeated any number of times before final deployment. - If the coiled members are unsecured relative to the cannula at their proximal ends, as depicted in
FIGS. 14-15 , then the cannula may be rotated in the opposite direction to achieve deployment, as compared to the coiledmember 40 ofFIGS. 1-2 that is unsecured at its distal end. In any of the embodiments herein, the cannula may comprise one or more coiled members that are unsecured at their proximal ends or unsecured at their distal ends, or combinations thereof in which at least one coiled member is unsecured proximally and at least one coiled member is unsecured distally. - Referring to
FIGS. 16-17 , examples of stents that are suitable for use as theinner stent 195 ofFIG. 15 , which may be coupled to the secondcoiled member 180, are shown and described. InFIG. 16 , astent 195a comprise a zig-zag shape comprising first and second generallystraight segments apices 193. Aneyelet 194 may be coupled to one of theapices 193, as shown inFIG. 16 , or any other suitable segment of thestent 195a. In use, the unsecured, spaced-apartproximal turns 183a of the secondcoiled member 180 are disposed through theeyelet 194 of thestent 195a, thereby securing thestent 195a to the secondcoiled member 180. - In
FIG. 17 , astent 195b comprises a cannula-cut structure having first andsecond cells circumferential slit 197 is formed in the spacing to create aring member 198, and abore 199 then is formed within thering member 198, as depicted inFIG. 17 . Thering member 198 having thebore 199 then may be bent radially inward at a desired angle, such as between 45 and 90 degrees, and then heat-set into the bent position, as generally described with respect to thering member 73" and 73"' ofFIGS. 12-13 , to facilitate engagement with the secondcoiled member 180. - Referring to
FIG. 18 , analternative apparatus 120' is shown for deploying a plurality of stent portions using a plurality of coiled members, and is similar to theapparatus 120 ofFIGS. 14-15 , with main exceptions noted below. In particular, an alternative cannula 130' of theapparatus 120' comprises a plurality oftapers tapers FIG. 2 , of the first and secondcoiled members tapers coiled members coiled members tapers coiled members - Referring now to
FIGS. 19-20 , a furtheralternative apparatus 220 is shown for deploying a portion of astent 260 using a coiledmember 240. InFIGS. 19-20 , acannula 230, which is similar to thecannula 30 described above, comprises anouter surface 231, anatraumatic tip 235, and awire guide lumen 239. Thecoiled member 240 comprises proximal anddistal ends turns 243 disposed therebetween. Thedistal end 242 of the coiledmember 240 is secured to theouter surface 231 of thecannula 230, e.g., using solder orweld 249, while theproximal end 241 of the coiledmember 240 is unsecured relative to theouter surface 231 of thecannula 230, as depicted inFIGS. 19-20 . - The
apparatus 220 further comprises aswivel 270 coupled to thecannula 230 at a location proximal to the coiledmember 240, and a plurality ofsuture loops suture loops proximal region 276 that is coupled to theswivel 270, e.g., by being disposed through abore 271 in theswivel 270, and further comprises adistal region 277 that is retained in a delivery state beneath one of the plurality ofturns 243 of the coiledmember 240, as depicted inFIGS. 19-20 . Thestent 260 comprises a firstproximal apex 262a that is coupled to thesuture loop 275a, and further comprises a secondproximal apex 262b that is coupled to thesuture loop 275b. Thesuture loops 275a and 275 are disposed around portions of the first and second proximal apices 262a and 262b, respectively, in a manner that restrains the first and second proximal apices 262a and 262b in the delivery state ofFIG. 19 . - The first and second proximal apices 262a and 262b of the
stent 260 are movable between a first configuration ofFIG. 19 in which they are restrained radially inward, a second configuration ofFIG. 20 in which they are at least partially deployed radially outward, and a final configuration in which they are fully deployed. In the first configuration ofFIG. 19 , thedistal regions 277 of thesuture loops turns 243 at a location distally away from theswivel 270, thereby maintaining thesuture loops suture loops cannula 230, which holds the first and second proximal apices 262a and 262b in a radially restrained state. In the second configuration ofFIG. 20 , thecannula 230 may be rotated in a direction that causes thedistal regions 277 of thesuture loops swivel 270, thereby providing slack for thesuture loops - Advantageously, if a physician does not wish to ultimately deploy the first and second proximal apices 262a and 262b when in the partially deployed state of
FIG. 20 , the physician may then rotate thecannula 230 in an opposing direction that causes thesuture loops FIG. 19 , thereby allowing for repositioning of the first and secondproximal apices 262a any number of times after partial deployment. Therefore, the embodiment ofFIGS. 19-20 provides a degree ofreversibility prior to final deployment. Ultimately, a physician can deploy the first and second proximal apices 262a and 262b at the desired location by rotating thecannula 230 to cause thedistal regions 277 of thesuture loops proximal end 241 of the coiledmember 240. Thesuture loops cannula 230 may be removed from the patient's body with thesuture loops swivel 270. - Optionally, if circumferential orientation of the
stent 260 is important, then to permit better circumferential positioning at the proximal end of thestent 260, a single trigger wire or other means may be used to temporarily lock theswivel 270 in place circumferentially as thestent 260 is positioned within the body. In this example, the single trigger wire or other means can be disengaged from theswivel 270, e.g., by being withdrawn from one of thebores 271 of theswivel 270, upon proper orientation within the body when thestent 260 is still in the delivery state, to thereby permit subsequent rotation of theswivel 270 and allowing unwinding of thesuture loops member 240 as thecannula 230 is rotated. - Referring now to
FIGS. 21-24 , anapparatus 320 is shown for deploying a portion of astent 360 using at least onecoiled member 140, and comprises aprotective cage 370 for enclosing thecoiled member 140. In this example, the exemplarycoiled member 140 is the same coiled member that is secured to theouter surface 131 of thecannula 130, as explained above inFIG. 14 , though it is contemplated that theprotective cage 370 may be used in conjunction with other coiled members, including those alternative coiled members shown herein. - The
protective cage 370 comprises afirst end 371 having an outer diameter dc1, and asecond end 372 having a second outer diameter dc2, as best seen inFIGS. 21 and24 . In the embodiment ofFIGS. 21-24 , where the exemplarycoiled member 140 is secured to thecannula 130 at its distal end and unsecured at its proximal end, then thefirst end 371 having the first outer diameter dc1 will be the proximal end of theprotective cage 370, while thesecond end 372 having the second outer diameter dc2 will be the distal end of theprotective cage 370. It is noted that the diameter at the first orproximal end 371 of theprotective cage 370 can be larger to accommodate the greater diameter of the coil at its unsecured proximal end that is spaced apart relative to thecannula 130, as depicted by separation orgap 44 inFIG. 2 above. At the second ordistal end 372 of theprotective cage 370, the reduced second outer diameter dc2 may be provided because the diameter of the coiledmember 140 is reduced for coupling to thecannula 130. Further, the second ordistal end 372 of theprotective cage 370 may be positioned distally of the coiledmember 140, as shown inFIG. 21 , and the second outer diameter dc2 may be slightly larger than theouter surface 131 of thecannula 130. It should be noted that ataper 374 reduces the diameter of theprotective cage 370 between the first end having the outer diameter dc1 and the second end having the reduced outer diameter dc2. - It should be noted that, if the unsecured end of the coiled member is located distally instead of proximally, then the axial orientation of the
protective cage 370 may be reversed. For example, if the coiledmember 40 ofFIGS. 1-2 and4-5 is used, which is unsecured at its distal end, then theprotective cage 370 may have thefirst end 371 of greater diameter located distally, while thesecond end 372 of lesser diameter is located proximally, thereby generally corresponding to the shape of the coiled member. - In the embodiment of
FIGS. 21-24 , theprotective cage 370 further comprises a plurality of struts 375 separated by a plurality ofslots 376. In this non-limiting example, fourstruts 375a-375d are depicted as being separated by fourslots 376a-376d, as depicted among the variousFIGS. 21-22 ,23A-23C and 24 . However, any number of slots and struts may be provided. Moreover, the number of slots may correspond directly to the number of proximal apices 361 of thestent 360 that need to be restrained, as generally depicted inFIG. 22 and explained below, or there may be variability between the number of slots and the number of proximal apices of thestent 360. - Each of the
struts 375a-375d andslots 376a-376d have proximal and distal ends, and are generally parallel to each other in a direction running along a longitudinal axis of the apparatus, as shown inFIG. 21 . Each of theslots 376a-376d has a width that is greater than a width of the proximal apices 361 of thestent 360, thereby allowing portion of the proximal apices 361 to extend through an associated slot, as depicted inFIG. 22 . Each of theslots 376a-376d may accommodate one proximal apex 361, or multiple proximal apices. - In one embodiment, the
protective cage 370 is designed to cooperate with at least a portion of anatraumatic tip 335. InFIGS. 21-24 , theatraumatic tip 335 may comprise proximal anddistal regions central region 338 disposed therebetween. The proximal anddistal regions central region 338, with a first taper allowing for a smooth transition between theproximal region 336 and thecentral region 338, and a second taper allowing for a smooth transition between thedistal region 337 and thecentral region 338. Theproximal region 336 may comprise a similar shape to theproximal region 36 of theatraumatic tip 35 ofFIG. 1 andFIGS. 4-5 . - The
distal region 337 of theatraumatic tip 335 may comprise an outer surface that corresponds to the shape of an inner surface at a proximal region of theprotective cage 370. In particular, theprotective cage 370 comprises a proximalinner taper 381, as shown inFIG. 24 . The outer surface of thedistal region 337 of theatraumatic tip 335 generally annularly abuts the proximalinner taper 381 in an assembled state. - In accordance with one embodiment, the
protective cage 370 can rotate circumferentially relative to theatraumatic tip 335 and thecannula 130. Notably, the proximalinner taper 381 of theprotective cage 370 is disposed around thedistal region 337 of theatraumatic tip 335, while thedistal end 372 of theprotective cage 370 is disposed around theouter surface 131 of thecannula 130. Since the proximal and distal regions of theprotective cage 370 are not secured to theatraumatic tip 335 and thecannula 130, respectively, theprotective cage 370 can rotate circumferentially relative to these adjacent components. - A
distal stop member 379 may be positioned adjacent to thedistal end 372 of theprotective cage 370, as shown inFIG. 21 . Thedistal stop member 379 allows theprotective cage 370 to rotate relative to thecannula 130, but prevents theprotective cage 370 from sliding distally over thecannula 130. Thedistal stop member 379 may be formed integrally with thecannula 130, or as an external component secured to theouter surface 131 of the cannula, and may comprise any suitable biocompatible material. - The proximal
inner taper 381 of theprotective cage 370 extends inward to anopening 382, shown inFIG. 24 , which has a diameter that allows passage of thecannula 130 so that thecannula 130 can be coupled to theatraumatic tip 335. Moreover, a steppedsurface 383 is provided just distal to theopening 382, as shown inFIG. 24 . The steppedsurface 383 may be generally perpendicular to the longitudinal axis of thecannula 130. The steppedsurface 383 prevents the proximal apices 361 of thestent 360 from sliding off of the coiledmember 140 prematurely, and may reduce the possibility that the proximal apices 361 of thestent 360 become inadvertently lodged under thestruts 375a-375d. Preferably, theproximal end 141 of the coiledmember 140 is disposed immediately adjacent to the steppedsurface 383, as depicted inFIG. 21 , thereby further reducing the possibility of inadvertent uncoupling of the proximal apices 361 of thestent 360 from the coiledmember 140 prior to desired rotation of thecannula 130. - The
protective cage 370 further comprises amain housing 384, which is disposed between the steppedsurface 383 and thedistal end 372, as shown inFIG. 24 . Themain housing 384 is sized for housing the coiledmember 140 therein, and has an inner diameter that remains larger than the coiled member along its longitudinal length, thereby permitting rotation of the coiledmember 140 within themain housing 384. - The
protective cage 370 may be formed from stainless steel, Nitinol, polymers, or other suitable biocompatible materials. Moreover, theprotective cage 370 may be manufactured as a single component, or multiple components that are secured together. In one embodiment, theprotective cage 370 may be manufactured by forming an outer shell of material, and then inserting material that forms the proximalinner taper 381 and the steppedsurface 383, and separately cutting theslots 376a-376d into the outer shell. - In the non-limiting example of
FIG. 22 , thestent 360 comprises a series of proximal apices 361 and a series ofdistal apices 363. Each of the proximal anddistal apices 361 and 363 are separated by a plurality ofstrut segments FIG. 22 to a generally cylindrical expanded state similar to thestent 60 depicted inFIG. 4 . Thedistal apices 363 may be coupled tograft material 90 using sutures threaded through one ormore bores 364 formed in thedistal apices 363 that overlap with the graft material, as shown inFIG. 22 . - The manner of using the
apparatus 320 is similar to use of theprior apparatuses FIGS. 21-24 , the proximal apices 361 of thestent 360 are coupled to the coiled member through theslots 376a-376d. For example, a firstproximal apex 361a may be positioned over theslot 376a, as depicted inFIG. 22 , and theproximal end 141 of the coiledmember 140 may be aligned with acoupling member 362 of the firstproximal apex 361a. Thecoupling member 362 ofFIG. 22 may be in the form of thesuture loop 65, thewire loop 54, or any one of theeyelets proximal apex 361a, which can be coupled or looped around theproximal end 141 of the coiledmember 140. Theproximal apex 361a may be pushed radially inward and held steady, while thecannula 130 and thecoiled member 140 are rotated in a first direction, thereby allowing thecoupling member 362 of theproximal apex 361a to be wound in a proximal to distal direction securely about the coiledmember 140. Subsequently, a secondproximal apex 361b may be positioned over theslot 376b and the same process achieved to couple the secondproximal apex 361b about the coiledmember 140, and this process may be repeated until all of the proximal apices 361 of thestent 360 are coupled to the coiledmember 140, through theslots 376a-376d, as shown inFIG. 22 . As noted above, there may be a one-to-one ratio of proximal apices 361 of thestent 360 to slots in theprotective cage 370, or alternatively, multiple proximal apices 361 of thestent 360 may be coupled to the coiledmember 140 through the same slot in theprotective cage 370. - After all of the proximal apices 361 of the
stent 360 are coupled to the coiledmember 140 through theslots 376a-376d of the protective member, a physician may deploy thestent 360 in the same manner as the explained inFIGS. 4-5 above. In particular, upon proper positioning at the target site using a desired imaging modality, an outer sheath is retracted to expose at least a portion of thestent 360. When thestent 360 is at least partially exposed, and it is desirable to deploy the proximal end of thestent 360, thecannula 130 may be rotated in a counter-clockwise direction until thecoupling member 362 of the firstproximal apex 361a is uncoupled from the coiledmember 140, i.e., in a reverse manner from which these connectors were coupled to the coiledmember 140. Thestent 360 then may be deployed as shown inFIG. 4 above, and the remainder of the stent-graft may be deployed by further retraction of the outer sheath or actuation of any other devices that are radially constraining the remainder of the stent-graft. - Advantageously, during deployment of the
stent 360 using theprotective cage 370, theprotective cage 370 can rotate circumferentially relative to theatraumatic tip 335 and thecannula 130. This allows the orientation of theprotective cage 370 and the stent apices 361 to remain generally the same while thecannula 130 and thecoiled member 140 are rotated circumferentially during deployment. - As a further advantage, the
protective cage 370 encloses the coiledmember 140 and reduces the possibility that thecoiled member 140 can interfere with, damage, or snag various endovascular, stent or graft structures during manipulation and removal of the delivery device. Theprotective cage 370 also may reduce the likelihood of apices of thestent 360 becoming caught on thecoiled member 140 by providing a guided release for the apices. - As noted above, if the unsecured end of the coiled member is located distally instead of proximally, then the axial orientation of the
protective cage 370 may be reversed. Moreover, if multiple coiled members are used, e.g., as in the embodiment ofFIGS. 14-15 , then multipleprotective cages 370 may be provided that each enclose a different coiled member. - Referring now to
FIG. 25 , an alternative protective cage 370' is similar to theprotective cage 370 ofFIGS. 21-24 , with like reference numbers representing like parts, except as noted below. In this example, an enclosingmember 390 that surrounds thedistal end 142 of the coiledmember 140 that is secured to theouter surface 131 of thecannula 130. The enclosingmember 390 may comprise afirst end 391 that is spaced apart from thecannula 130 to accommodate a portion of the coiledmember 140, asecond end 392 that is secured to theouter surface 131 of thecannula 130, and atapered region 394 that bridges the different diameters of the first and second ends 391 and 392, as depicted inFIG. 25 . The alternative protective cage 370' may comprise a longitudinal region 374', as shown inFIGS.25 , which comprises an intermediate outer diameter dc3, which has a dimension less than thefirst end 371 having the outer diameter dc1 and greater than thesecond end 372 having the outer diameter dc2 ,as depicted in the earlier embodiment ofFIG. 24 . The longitudinal region 374' further has an inner diameter that is slightly larger than an outer diameter at thefirst end 391 of the enclosingmember 390. Advantageously, the enclosingmember 390 provides a barrier between a portion of the coiledmember 140 and the protective cage 370', which may reduce potential drawbacks arising from direct interference between thedistal end 142 of the coiledmember 140 and the protective cage 370'. - Referring now to
FIG. 26 , an alternativeprotective cage 370" is similar to theprotective cages 370 and 370' above, with a main exception that a plurality of slots 376' hasproximal regions 377 that are wider thandistal regions 378. The widening ofproximal regions 377 of the slots 376' may yield an easier time coupling thestent 360 to the coiledmember 140 during loading, and may facilitate release of thestent 360 from the coiledmember 140 given less potential interference from theproximal region 377 of the slots 376'. The proximal apices 361 of thestent 360 can also be modified, e.g., with widened proximal tips, so that they only side out of theprotective cage 370" at theproximal region 377 of the slots 376'. - Referring now to
FIGS. 27-28 , two different stent designs are shown, which are alternatives to thestents FIG. 27 , a stent 360', which is shown in a flattened and compressed state, comprises a series of proximal apices 361' and a series of distal apices 363'. Each of the proximal and distal apices 361' and 363' are separated by a plurality of strut segments 365' and 366', which enable radial expansion from the compressed state shown inFIG. 27 to a generally cylindrical expanded state similar to thestent 60 depicted inFIG. 4 . - Each of the proximal apices 361' comprises the
coupling member 362, as explained with respect toFIG. 22 above, and further comprises anintegral barb 367. Each of the distal apices 363' comprises a suture bore 364', animaging marker 368, and anintegral barb 369. The suture bore 364' overlaps withgraft material 90, as depicted inFIG. 22 , and allows suturing of a portion of each distal apex 363' to thegraft material 90. Theimaging marker 368, which is disposed proximal to the suture bore 364', may be aligned precisely with the proximal edge of thegraft material 90 to enable precise placement of the proximal edge under an imaging modality. - The stent 360' may comprise any
number 361n' of proximal apices 361', where "n" is the number of apices. In the example ofFIG. 27 , "n" is equal to twelve, and each of the twelveproximal apices 361a' through 361n' have identical characteristics, including axial lengths. A firstproximal apex 361a' is loaded onto the coiledmember coupling member 362, and each subsequent proximal apex 361 is secured to the coiledmember proximal apices 361a' through 361n' comprises a region having a relativelythin strut segment 388, having a notchedregion 389 formed therein, which advantageously may permit this region of the proximal apex to rotate or bend to facilitate coupling to the coiledmember proximal extension segment 74 ofFIGS. 6-8 . - Referring now to
FIG. 28 , analternative stent 360" is identical to the stent 360' ofFIG. 27 , with the exception that alternative proximal apices 361" comprise different axial lengths relative to one another. In the example ofFIG. 28 , each of the alternative proximal apices 361" comprises a progressively larger axial length, such that a firstproximal apex 361a" comprises the smallest axial length, while the lastproximal apex 361n" comprises the greatest axial length. Axial lengths of relatively thin strut segments 388' and their associated notchedregions 389' may be varied to achieve the length differential between proximal apices 361a" through 361n", which yields a staggered axial positioning of thecoupling members 362 of each apex, as shown inFIG. 28 . The firstproximal apex 361a" is loaded onto the coiledmember coupling member 362, and each subsequent proximal apex 361 is secured to the coiledmember proximal apex 361n" is secured to the coiled member. - The axial length differential between
coupling members 362 of adjacent proximal apices 361a" through 361n" can be determined according to the formula i = p/n, where " i " is the axial length betweencoupling members 362 of adjacent proximal apices 361a" through 361n", " p " is the pitch of the coiled member, and " n " is the number of proximal apices. For example, where there are twelve proximal apices 361a" through 361n", the value of " i " may equal 0.167mm where the pitch of the coiled member is 2.0mm, i.e., i = p/n corresponds to 0.167mm = 2.0mm/12. - Advantageously, by modifying the axial length between adjacent proximal apices 361a" through 361n", and yielding the staggered axial positioning of the
coupling members 362 of each apex, capture of thecoupling members 362 may be facilitated during securement to the coiledmembers coupling members 362 can endure lower strains since the firstproximal apex 361a" does not have to bend more to accommodate other points during the loading process. The proximal apices 361a" through 361n" can therefore be positioned in a uniform radially about the coiledmember - Referring now to
FIG. 29 , an alternativeatraumatic tip 435 comprises proximal anddistal regions central region 438 disposed therebetween. The proximal anddistal regions central region 438, with a first taper allowing for a smooth transition between theproximal region 436 and thecentral region 438, and a second taper allowing for a smooth transition between thedistal region 437 and thecentral region 438. In this example, adistal taper 439 is formed at an angle α relative to thecentral region 438 and also to the main longitudinal axis of the device. The angle α preferably is minimized to achieve a minimal distance for threading thecoupling members 362 of the stents on and off the coiledmembers distal face 449 of theatraumatic tip 439 may be greater than the second outer diameter d2 of the coiledmember 140, as illustrated previously. By having the second outer diameter d2 of the coiledmember 140 be less than the length of thedistal face 449 of theatraumatic tip 439, the chances of inadvertent snagging of theproximal end 141 of the coiledmember 140 may be reduced. - Further, a distance x between the
proximal end 141 of the coiledmember 140 and the distal end of theatraumatic tip 435 may be optimized so that the distance x is just slightly larger than an axial length necessary for coupling thecoupling members 362 of the stents on and off the coiledmembers coupling members 362 of the stents becoming inadvertently disengaged from the coiledmembers member 140 snagging on another part of the delivery system or a bodily structure may be reduced. - Referring now to
FIGS. 30-32 , an alternativeatraumatic tip 435' is similar to theatraumatic tip 435 ofFIG. 29 , but comprises an alternative distal region 437' having a notchedregion 440 formed in the distal face of theatraumatic tip 435'. The notchedregion 440 generally follows at least a portion of the profile of the coiledmember 140, as shown inFIG. 30 . Further, the distance x between theproximal end 141 of the coiled member and the distal end of theatraumatic tip 435, as explained inFIG, 29 , may be maintained in the embodiment ofFIGS. 30-32 , although in an angled manner that corresponds to the angular profile of the coiledmember 140, as best seen inFIG. 30 . - In this example, the notched
region 440 follows the contours of alongitudinal notch 441 andangled segments coiled member 140 and theatraumatic tip 435' to be maintained while theproximal end 141 of the coiledmember 140 at least partially axially overlaps with theatraumatic tip 435'. A first state of the delivery system is shown inFIGS. 30 and31 , in which theproximal end 141 of the coiledmember 140 at least partially axially overlaps with theatraumatic tip 435', may be used during delivery into, and removal from, a patient's vascular system. A second state of the delivery system is shown inFIGS. 32 , in which theproximal end 141 of the coiledmember 140 has been rotated to be disposed distal to the atraumatic tip, may occur during deployment as the stent-graft is held longitudinally steady. In one further embodiment, theatraumatic tip 435' may be longitudinally movable relative to the coiledmember 140, such that when deployment of the stent-graft is completed, theatraumatic tip 435' may be advanced distally relative to the coiledmember 140 until theproximal end 141 of the coiled member is at least partially seated within the notchedregion 440 of theatraumatic tip 435' for subsequent removal from the vasculature. - In the embodiment of
FIGS. 30-32 , multiple advantages are achieved. First, the likelihood of thecoupling members 362 of the stents becoming inadvertently disengaged from the coiledmember 140 is reduced. Further, since theproximal end 141 of the coiledmember 140 at least partially axially overlaps with theatraumatic tip 435', the likelihood of the coiledmember 140 snagging on another part of the delivery system or a bodily structure may be significantly reduced. - Referring now to
FIGS. 33-35 , a further alternativeatraumatic tip 435" is similar to theatraumatic tips FIGS. 29-32 , but comprises an alternativedistal region 437" having a notchedregion 440", and an alternativecentral region 438" having achannel 450. It is noted that thecoiled member 140 is omitted inFIG. 33 for clarity, but is shown inFIG. 35 . - The notched
region 440" may comprise taperedwall portions valley 443. Thevalley 443 has proximal anddistal ends FIG. 35 . Theproximal end 443a of thevalley 443 may transition into thechannel 450 of thecentral region 438" of theatraumatic tip 435". Thechannel 450 may be used as a conduit for delivering flushing fluid, which may be provided in a distal to proximal direction through thevalley 443 and subsequently through thechannel 450. - The
distal end 443b of thevalley 443 is disposed in close longitudinal proximity, and preferably slightly proximal to, theproximal end 141 of the coiledmember 140. The distance between theproximal end 141 of the coiledmember 140 and the distal end of theatraumatic tip 435" remains such that there is sufficient space for thecoupling members 362 of stents to be released from the coiledmember 140, as described above. Further, theproximal end 141 of the coiledmember 140 may terminate at a circumferential location slightly offset from the center of thevalley 443. For example, inFIG. 35 , theproximal end 141 of the coiledmember 140 is shown slightly above the center of thevalley 443, and about even with the taperedwall portion 441. In this manner, the center of thevalley 443 will be aligned precisely with thecoupling members 362 as they exit from engagement with theproximal end 141 of the coiledmember 140. - In the embodiment of
FIGS. 33-35 , multiple advantages are achieved. As one example, thevalley 443 may significantly reduce the likelihood of theatraumatic tip 435" becoming caught on a radially deployedcoupling member 362. In particular, after deployment of the stent, the delivery system including theatraumatic tip 435" will be retracted distally outside of the patient, and during the phase of initial retraction, thevalley 443 helps provide a ramp-like feature to ensure that the deployedcoupling member 362 of the stents will not become caught on theatraumatic tip 435" upon its removal. - The
valley 443 of the notchedregion 440" also provides a ramp-like pathway for thecoupling members 362 to follow as they move radially outward from theproximal end 141 of the coiledmember 140 towards a vessel wall. Accordingly, the provision of thevalley 443 may significantly reduce the likelihood of thecoupling members 362 of the stents becoming caught on theatraumatic tip 435" during deployment, in addition to after deployment. - While various embodiments of the invention have been described, the invention is not to be restricted except in light of the attached claims and their equivalents. Moreover, the advantages described herein are not necessarily the only advantages of the invention and it is not necessarily expected that every embodiment of the invention will achieve all of the advantages described.
- All optional features and modifications of the described embodiments and dependent claims are usable in all aspects of the invention taught herein. Furthermore, the individual features of the dependent claims, as well as all optional and preferred features and modification of the described embodiments are combinable and interchangeable with one another.
- The disclosures in United States patent application numbers
61/659,255 61/745,181 13/796,591 13/796,395
Claims (18)
- A system for deploying at least a portion of a stent, the system including:a cannula having an outer surface;at least one coiled member having proximal and distal ends and a plurality of turns disposed therebetween; anda stent,where one of the proximal and distal ends of the coiled member is secured to the outer surface of the cannula, and the other of the proximal and distal ends of the coiled member is unsecured relative to the outer surface of the cannula,where a portion of the stent is looped around the unsecured end of the coiled member and further is disposed within spacing between adjacent turns of the coiled member in a delivery state.
- The system of claim 1, wherein the proximal end of the coiled member is secured to the outer surface of the cannula and the distal end of the coiled member is unsecured relative to the outer surface of the cannula, such that the portion of the stent is looped around the distal end of the coiled member and further is disposed within spacing between adjacent distal turns of the coiled member in the delivery state.
- The system of claim 2, wherein a distal series of turns of the coiled member are spaced apart further from one another relative to spacing between a proximal series of turns.
- The system of claim 2 or 3, wherein the proximal end of the coiled member comprises a first diameter that permits attachment to the outer surface of the cannula, where the distal end of the coiled member comprises a second diameter that is greater than the first diameter, and where there is a gap disposed between the distal end of the coiled member and the outer surface of the cannula.
- The system of any preceding claim, wherein the distal end of the coiled member is secured to the outer surface of the cannula and the proximal end of the coiled member is unsecured relative to the outer surface of the cannula, such that the portion of the stent is looped around the proximal end of the coiled member and further is disposed within spacing between adjacent proximal turns of the coiled member in the delivery state.
- The system of preceding claim, wherein first and second coiled members are provided and are longitudinally spaced apart from one another along a length of the cannula, wherein the first coiled member engages a first stent portion in the delivery state and the second coiled member engages a second stent portion in the delivery state.
- The system of claim 6, wherein the first coiled member comprises a greater number of turns that are unsecured relative to the cannula than the second coiled member, thereby enabling the second stent portion to disengage from the second coiled member before the first stent portion disengages from the first coiled member when the cannula is rotated in a uniform direction.
- The system of preceding claim, including protective cage encircling the coiled member.
- The system of claim 8, wherein the protective cage comprises a plurality of struts separated by a plurality of slots, where a portion of the stent that is releasably secured to the coiled member extends through one of the plurality of slots in a delivery state.
- The system of claim 9, wherein each of the plurality of struts and each of the plurality of slots are generally parallel to each other in a direction running along a longitudinal axis of the apparatus.
- The system of claim 8, 9 or 10, wherein at least one of the plurality of slots has proximal and distal regions and a width at the proximal region is greater than a width at the distal regions.
- The system of claim 8, 9, 10 or 11, wherein the protective cage is circumferentially rotatable relative to the cannula.
- The system of any one of claims 8 to 12, including a distal stop member coupled to the cannula and positioned adjacent to a distal end of the protective cage, where the distal stop member allows the protective cage to rotate relative to the cannula, but prevents the protective cage from sliding distally over the cannula.
- The system of any preceding claims, including an atraumatic tip coupled to the cannula, where the atraumatic tip comprises at least one notched region, and the coiled member is at least partially seated within the notched region of the atraumatic tip during removal of the system from a patient's vasculature.
- The system of any preceding claim, wherein one of proximal or distal ends of the stent comprises a plurality of apices that each comprises a coupling member that is releasably secured to the coiled member, where longitudinal positions of the coupling members of adjacent apices are axially staggered relative to each other.
- The system of claim 15, wherein the axial length differential between adjacent proximal apices is calculated based on a formula factoring into account at least the pitch of the coiled member.
- The system of any preceding claim, including a suture loop coupled to a portion of the stent, wherein the suture loop is dimensioned to be accommodated within the spacing between the adjacent turns of the coiled member in the delivery state.
- The system of any preceding claim, including a ring portion extending from the stent, where the ring portion is dimensioned to be accommodated within the spacing between the adjacent turns of the coiled member in the delivery state.
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201261659255P | 2012-06-13 | 2012-06-13 | |
US201261745181P | 2012-12-21 | 2012-12-21 | |
US13/796,395 US9173756B2 (en) | 2012-06-13 | 2013-03-12 | Systems and methods for deploying a portion of a stent using at least one coiled member |
US13/796,591 US9364355B2 (en) | 2012-06-13 | 2013-03-12 | Systems and methods for deploying a portion of a stent using at least one coiled member |
Publications (2)
Publication Number | Publication Date |
---|---|
EP2674135A1 true EP2674135A1 (en) | 2013-12-18 |
EP2674135B1 EP2674135B1 (en) | 2017-10-18 |
Family
ID=48782850
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP13171753.0A Active EP2674135B1 (en) | 2012-06-13 | 2013-06-12 | Systems and methods for deploying a portion of a stent using at least one coiled member |
Country Status (2)
Country | Link |
---|---|
EP (1) | EP2674135B1 (en) |
CA (1) | CA2818268C (en) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP2810623A3 (en) * | 2013-06-05 | 2016-06-01 | Asahi Intecc Co., Ltd. | Pusher guidewire |
WO2021226418A1 (en) * | 2020-05-08 | 2021-11-11 | Medtronic Vascular, Inc. | Delivery system for prosthetic valve device having controlled release of inflow and outflow ends |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1998053761A1 (en) | 1997-05-26 | 1998-12-03 | William A. Cook Australia Pty. Ltd. | A prosthesis and a method and means of deploying a prosthesis |
US20090192585A1 (en) * | 2008-01-24 | 2009-07-30 | Medtronic, Inc. | Delivery Systems and Methods of Implantation for Prosthetic Heart Valves |
US20090306761A1 (en) * | 2008-06-06 | 2009-12-10 | Bay Street Medical | Prosthesis and delivery system |
US20100249896A1 (en) * | 2009-03-31 | 2010-09-30 | Terumo Kabushiki Kaisha | Stent delivery system |
US20110251664A1 (en) * | 2010-04-08 | 2011-10-13 | Medtronic Vascular, Inc. | Short Legged Bifurcated Stent Graft Distal Capture Element and Method |
-
2013
- 2013-06-07 CA CA2818268A patent/CA2818268C/en active Active
- 2013-06-12 EP EP13171753.0A patent/EP2674135B1/en active Active
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1998053761A1 (en) | 1997-05-26 | 1998-12-03 | William A. Cook Australia Pty. Ltd. | A prosthesis and a method and means of deploying a prosthesis |
US20090192585A1 (en) * | 2008-01-24 | 2009-07-30 | Medtronic, Inc. | Delivery Systems and Methods of Implantation for Prosthetic Heart Valves |
US20090306761A1 (en) * | 2008-06-06 | 2009-12-10 | Bay Street Medical | Prosthesis and delivery system |
US20100249896A1 (en) * | 2009-03-31 | 2010-09-30 | Terumo Kabushiki Kaisha | Stent delivery system |
US20110251664A1 (en) * | 2010-04-08 | 2011-10-13 | Medtronic Vascular, Inc. | Short Legged Bifurcated Stent Graft Distal Capture Element and Method |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP2810623A3 (en) * | 2013-06-05 | 2016-06-01 | Asahi Intecc Co., Ltd. | Pusher guidewire |
WO2021226418A1 (en) * | 2020-05-08 | 2021-11-11 | Medtronic Vascular, Inc. | Delivery system for prosthetic valve device having controlled release of inflow and outflow ends |
US12016774B2 (en) | 2020-05-08 | 2024-06-25 | Medtronic Vascular, Inc. | Delivery system for prosthetic valve device having controlled release of inflow and outflow ends |
Also Published As
Publication number | Publication date |
---|---|
EP2674135B1 (en) | 2017-10-18 |
CA2818268C (en) | 2016-07-19 |
CA2818268A1 (en) | 2013-12-13 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US10993823B2 (en) | Systems and methods for deploying a portion of a stent using at least one coiled member | |
US9144510B2 (en) | Systems and methods for deploying a portion of a stent using at least one coiled member | |
US9629733B2 (en) | Stents having barbs protected during delivery | |
US10905575B2 (en) | Circumferential trigger wire for deploying an endoluminal prosthesis | |
US10695205B2 (en) | Systems and methods for securing and releasing a portion of a stent | |
CN110114037B (en) | Radially adjustable stent graft delivery system | |
CN109890331B (en) | Stent-graft delivery system with a shrink sheath and method of use | |
US10639180B2 (en) | Systems and methods for deploying a portion of a stent using an auger-style device | |
EP2674135B1 (en) | Systems and methods for deploying a portion of a stent using at least one coiled member | |
EP2727563B1 (en) | Apparatus for improved stent deployment | |
EP2842526B1 (en) | System for deploying at least a portion of a stent |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
PUAI | Public reference made under article 153(3) epc to a published international application that has entered the european phase |
Free format text: ORIGINAL CODE: 0009012 |
|
AK | Designated contracting states |
Kind code of ref document: A1 Designated state(s): AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR |
|
AX | Request for extension of the european patent |
Extension state: BA ME |
|
17P | Request for examination filed |
Effective date: 20140617 |
|
RBV | Designated contracting states (corrected) |
Designated state(s): AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR |
|
17Q | First examination report despatched |
Effective date: 20150519 |
|
STAA | Information on the status of an ep patent application or granted ep patent |
Free format text: STATUS: EXAMINATION IS IN PROGRESS |
|
REG | Reference to a national code |
Ref country code: DE Ref legal event code: R079 Ref document number: 602013028023 Country of ref document: DE Free format text: PREVIOUS MAIN CLASS: A61F0002950000 Ipc: A61F0002966000 |
|
RIC1 | Information provided on ipc code assigned before grant |
Ipc: A61F 2/966 20130101AFI20170303BHEP Ipc: A61F 2/07 20130101ALN20170303BHEP |
|
GRAP | Despatch of communication of intention to grant a patent |
Free format text: ORIGINAL CODE: EPIDOSNIGR1 |
|
STAA | Information on the status of an ep patent application or granted ep patent |
Free format text: STATUS: GRANT OF PATENT IS INTENDED |
|
INTG | Intention to grant announced |
Effective date: 20170502 |
|
RIN1 | Information on inventor provided before grant (corrected) |
Inventor name: ROEDER, BLAYNE Inventor name: HOPKINS, TONY Inventor name: KRATZBERG, JARIN Inventor name: VAD, SIDDARTH Inventor name: WAGNER, ZACHARY Inventor name: HADLEY, RICK Inventor name: HAVEL, WILLIAM Inventor name: DEBRUYNE, MICHAEL |
|
GRAS | Grant fee paid |
Free format text: ORIGINAL CODE: EPIDOSNIGR3 |
|
GRAA | (expected) grant |
Free format text: ORIGINAL CODE: 0009210 |
|
STAA | Information on the status of an ep patent application or granted ep patent |
Free format text: STATUS: THE PATENT HAS BEEN GRANTED |
|
AK | Designated contracting states |
Kind code of ref document: B1 Designated state(s): AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR |
|
REG | Reference to a national code |
Ref country code: GB Ref legal event code: FG4D |
|
REG | Reference to a national code |
Ref country code: CH Ref legal event code: EP |
|
REG | Reference to a national code |
Ref country code: AT Ref legal event code: REF Ref document number: 937280 Country of ref document: AT Kind code of ref document: T Effective date: 20171115 Ref country code: IE Ref legal event code: FG4D |
|
REG | Reference to a national code |
Ref country code: DE Ref legal event code: R096 Ref document number: 602013028023 Country of ref document: DE |
|
REG | Reference to a national code |
Ref country code: NL Ref legal event code: MP Effective date: 20171018 |
|
REG | Reference to a national code |
Ref country code: LT Ref legal event code: MG4D |
|
REG | Reference to a national code |
Ref country code: AT Ref legal event code: MK05 Ref document number: 937280 Country of ref document: AT Kind code of ref document: T Effective date: 20171018 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: NL Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: LT Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: SE Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: ES Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: NO Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20180118 Ref country code: FI Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: GR Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20180119 Ref country code: BG Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20180118 Ref country code: RS Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: AT Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: IS Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20180218 Ref country code: LV Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: HR Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
REG | Reference to a national code |
Ref country code: DE Ref legal event code: R097 Ref document number: 602013028023 Country of ref document: DE |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: EE Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: SK Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: DK Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: CZ Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
PLBE | No opposition filed within time limit |
Free format text: ORIGINAL CODE: 0009261 |
|
STAA | Information on the status of an ep patent application or granted ep patent |
Free format text: STATUS: NO OPPOSITION FILED WITHIN TIME LIMIT |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: PL Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: SM Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: IT Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: RO Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
26N | No opposition filed |
Effective date: 20180719 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: SI Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
REG | Reference to a national code |
Ref country code: CH Ref legal event code: PL |
|
REG | Reference to a national code |
Ref country code: BE Ref legal event code: MM Effective date: 20180630 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: MC Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: LU Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES Effective date: 20180612 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: FR Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES Effective date: 20180630 Ref country code: LI Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES Effective date: 20180630 Ref country code: CH Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES Effective date: 20180630 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: BE Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES Effective date: 20180630 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: MT Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES Effective date: 20180612 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: TR Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: HU Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT; INVALID AB INITIO Effective date: 20130612 Ref country code: PT Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: CY Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 Ref country code: MK Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES Effective date: 20171018 |
|
PG25 | Lapsed in a contracting state [announced via postgrant information from national office to epo] |
Ref country code: AL Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT Effective date: 20171018 |
|
P01 | Opt-out of the competence of the unified patent court (upc) registered |
Effective date: 20230602 |
|
PGFP | Annual fee paid to national office [announced via postgrant information from national office to epo] |
Ref country code: IE Payment date: 20240527 Year of fee payment: 12 |
|
PGFP | Annual fee paid to national office [announced via postgrant information from national office to epo] |
Ref country code: GB Payment date: 20240509 Year of fee payment: 12 |
|
PGFP | Annual fee paid to national office [announced via postgrant information from national office to epo] |
Ref country code: DE Payment date: 20240509 Year of fee payment: 12 |